@Article{info:doi/10.2196/10202,
author="Zanaboni, Paolo
and Ngangue, Patrice
and Mbemba, Claudine Gisele Ir{\`e}ne
and Schopf, Roger Thomas
and Bergmo, Strand Trine
and Gagnon, Marie-Pierre",
title="Methods to Evaluate the Effects of Internet-Based Digital Health Interventions for Citizens: Systematic Review of Reviews",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="07",
volume="20",
number="6",
pages="e10202",
keywords="review",
keywords="electronic health records",
keywords="patient access to records",
keywords="patient portals",
keywords="epidemiological methods",
keywords="evaluation studies as topic",
abstract="Background: Digital health can empower citizens to manage their health and address health care system problems including poor access, uncoordinated care and increasing costs. Digital health interventions are typically complex interventions. Therefore, evaluations present methodological challenges. Objective: The objective of this study was to provide a systematic overview of the methods used to evaluate the effects of internet-based digital health interventions for citizens. Three research questions were addressed to explore methods regarding approaches (study design), effects and indicators. Methods: We conducted a systematic review of reviews of the methods used to measure the effects of internet-based digital health interventions for citizens. The protocol was developed a priori according to Preferred Reporting Items for Systematic review and Meta-Analysis Protocols and the Cochrane Collaboration methodology for overviews of reviews. Qualitative, mixed-method, and quantitative reviews published in English or French from January 2010 to October 2016 were included. We searched for published reviews in PubMed, EMBASE, The Cochrane Database of Systematic Reviews, CINHAL and Epistemonikos. We categorized the findings based on a thematic analysis of the reviews structured around study designs, indicators, types of interventions, effects and perspectives. Results: A total of 20 unique reviews were included. The most common digital health interventions for citizens were patient portals and patients' access to electronic health records, covered by 10/20 (50\%) and 6/20 (30\%) reviews, respectively. Quantitative approaches to study design included observational study (15/20 reviews, 75\%), randomized controlled trial (13/20 reviews, 65\%), quasi-experimental design (9/20 reviews, 45\%), and pre-post studies (6/20 reviews, 30\%). Qualitative studies or mixed methods were reported in 13/20 (65\%) reviews. Five main categories of effects were identified: (1) health and clinical outcomes, (2) psychological and behavioral outcomes, (3) health care utilization, (4) system adoption and use, and (5) system attributes. Health and clinical outcomes were measured with both general indicators and disease-specific indicators and reported in 11/20 (55\%) reviews. Patient-provider communication and patient satisfaction were the most investigated psychological and behavioral outcomes, reported in 13/20 (65\%) and 12/20 (60\%) reviews, respectively. Evaluation of health care utilization was included in 8/20 (40\%) reviews, most of which focused on the economic effects on the health care system. Conclusions: Although observational studies and surveys have provided evidence of benefits and satisfaction for patients, there is still little reliable evidence from randomized controlled trials of improved health outcomes. Future evaluations of digital health interventions for citizens should focus on specific populations or chronic conditions which are more likely to achieve clinically meaningful benefits and use high-quality approaches such as randomized controlled trials. Implementation research methods should also be considered. We identified a wide range of effects and indicators, most of which focused on patients as main end users. Implications for providers and the health system should also be included in evaluations or monitoring of digital health interventions. ",
doi="10.2196/10202",
url="http://www.jmir.org/2018/6/e10202/"
}


@Article{info:doi/10.2196/10486,
author="Li, Jinhui
and Erdt, Mojisola
and Chen, Luxi
and Cao, Yuanyuan
and Lee, Shan-Qi
and Theng, Yin-Leng",
title="The Social Effects of Exergames on Older Adults: Systematic Review and Metric Analysis",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="28",
volume="20",
number="6",
pages="e10486",
keywords="active video games",
keywords="psychosocial well-being",
keywords="ageing",
keywords="literature review",
keywords="citation analysis",
abstract="Background: Recently, many studies have been conducted to investigate the effects of exergames on the social well-being of older adults. Objective: The aim of this paper is to synthesize existing studies and provide an overall picture on the social effects of exergames on older adults. Methods: A comprehensive literature search with inclusive criteria was conducted in major social science bibliographic databases. The characteristics of exergames, participants, methodology, as well as outcome measurements were extracted from the relevant studies included in the review. The bibliometric and altmetric outreach of the included studies were also investigated. Results: A total of 10 studies were included in the review, with 8 studies having used the Nintendo Wii platform. Most of the studies recruited healthy older adults from local communities or senior activity centers. Three groups of social-related outcomes have been identified, including emotion-related, behavior-related, and attitude-related outcomes. A metric analysis has shown that the emotion-related and behavior-related outcomes received high attention from both the academic community and social media platforms. Conclusions: Overall, the majority of exergame studies demonstrated promising results for enhanced social well-being, such as reduction of loneliness, increased social connection, and positive attitudes towards others. The paper also provided implications for health care researchers and exergame designers. ",
doi="10.2196/10486",
url="http://www.jmir.org/2018/6/e10486/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29954727"
}


@Article{info:doi/10.2196/jmir.8882,
author="Sarkar, Urmimala
and Le, M. Gem
and Lyles, R. Courtney
and Ramo, Danielle
and Linos, Eleni
and Bibbins-Domingo, Kirsten",
title="Using Social Media to Target Cancer Prevention in Young Adults: Viewpoint",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="05",
volume="20",
number="6",
pages="e203",
keywords="cancer",
keywords="prevention \& control",
keywords="young adult",
keywords="behavior",
keywords="social media",
doi="10.2196/jmir.8882",
url="http://www.jmir.org/2018/6/e203/"
}


@Article{info:doi/10.2196/jmir.8622,
author="Hekler, B. Eric
and Rivera, E. Daniel
and Martin, A. Cesar
and Phatak, S. Sayali
and Freigoun, T. Mohammad
and Korinek, Elizabeth
and Klasnja, Predrag
and Adams, A. Marc
and Buman, P. Matthew",
title="Tutorial for Using Control Systems Engineering to Optimize Adaptive Mobile Health Interventions",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="28",
volume="20",
number="6",
pages="e214",
keywords="adaptive interventions",
keywords="mHealth",
keywords="eHealth",
keywords="digital health",
keywords="control systems engineering",
keywords="behavior change",
keywords="optimization",
keywords="multiphase optimization strategy",
keywords="physical activity",
keywords="behavioral maintenance",
abstract="Background: Adaptive behavioral interventions are individualized interventions that vary support based on a person's evolving needs. Digital technologies enable these adaptive interventions to function at scale. Adaptive interventions show great promise for producing better results compared with static interventions related to health outcomes. Our central thesis is that adaptive interventions are more likely to succeed at helping individuals meet and maintain behavioral targets if its elements can be iteratively improved via data-driven testing (ie, optimization). Control systems engineering is a discipline focused on decision making in systems that change over time and has a wealth of methods that could be useful for optimizing adaptive interventions. Objective: The purpose of this paper was to provide an introductory tutorial on when and what to do when using control systems engineering for designing and optimizing adaptive mobile health (mHealth) behavioral interventions. Overview: We start with a review of the need for optimization, building on the multiphase optimization strategy (MOST). We then provide an overview of control systems engineering, followed by attributes of problems that are well matched to control engineering. Key steps in the development and optimization of an adaptive intervention from a control engineering perspective are then summarized, with a focus on why, what, and when to do subtasks in each step. Implications: Control engineering offers exciting opportunities for optimizing individualization and adaptation elements of adaptive interventions. Arguably, the time is now for control systems engineers and behavioral and health scientists to partner to advance interventions that can be individualized, adaptive, and scalable. This tutorial should aid in creating the bridge between these communities. ",
doi="10.2196/jmir.8622",
url="http://www.jmir.org/2018/6/e214/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29954725"
}


@Article{info:doi/10.2196/jmir.8616,
author="Hanna, M. Reem
and Fischer, Gary
and Conroy, B. Molly
and Bryce, Cindy
and Hess, Rachel
and McTigue, Kathleen",
title="Online Lifestyle Modification Intervention: Survey of Primary Care Providers' Attitudes and Views",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="08",
volume="20",
number="6",
pages="e167",
keywords="online intervention",
keywords="obesity",
keywords="health information technology",
keywords="referral model",
abstract="Background: Online tools are a convenient and effective method of delivering lifestyle interventions to obese adult primary care patients. A referral model allows physicians to efficiently direct their patients to the intervention during a primary care visit. However, little is known of physicians' perspectives and utilization of the referral model for an online lifestyle modification intervention. Objective: The aim was to evaluate the response of primary care providers (PCPs) to a referral model for implementing a year-long online intervention for weight loss to obese adult patients. Methods: The PCPs at six primary care clinics were asked to refer adult obese patients to a year-long online lifestyle intervention providing self-management support for weight loss. Following the 1-year intervention, all providers at the participating practices were surveyed regarding their views of the program. Respondents completed survey items assessing their attitudes regarding the 1-year intensive weight loss intervention and identifying resources they would find helpful for assisting patients with weight loss. Referring physicians were asked about their level of satisfaction with implementing the counseling services using standard electronic health record referral processes. Attitudes toward obesity counseling among referring and nonreferring providers were compared. Impressions of how smoothly the referral model of obesity treatment integrated with the clinical workflow were also quantified. Results: Of the 67 providers who completed the surveys, nonreferring providers (n=17) were more likely to prefer counseling themselves (P=.04) and to report having sufficient time to do so (P=.03) than referring providers (n=50) were. Nonreferring providers were more likely to report that their patients lacked computer skills (76\%, 13/17 vs 34\%, 17/50) or had less access to the Internet (65\%, 11/17 vs 32\%, 16/50). Conclusions: Understanding providers' views and barriers regarding the integration of online tools will facilitate widespread implementation of an online lifestyle modification intervention. ",
doi="10.2196/jmir.8616",
url="http://www.jmir.org/2018/6/e167/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29884605"
}


@Article{info:doi/10.2196/jmir.9275,
author="Fleming, Theresa
and Bavin, Lynda
and Lucassen, Mathijs
and Stasiak, Karolina
and Hopkins, Sarah
and Merry, Sally",
title="Beyond the Trial: Systematic Review of Real-World Uptake and Engagement With Digital Self-Help Interventions for Depression, Low Mood, or Anxiety",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="06",
volume="20",
number="6",
pages="e199",
keywords="e-therapy",
keywords="mobile applications",
keywords="eHealth",
keywords="depression",
keywords="anxiety",
abstract="Background: Digital self-help interventions (including online or computerized programs and apps) for common mental health issues have been shown to be appealing, engaging, and efficacious in randomized controlled trials. They show potential for improving access to therapy and improving population mental health. However, their use in the real world, ie, as implemented (disseminated) outside of research settings, may differ from that reported in trials, and implementation data are seldom reported. Objective: This study aimed to review peer-reviewed articles reporting user uptake and/or ongoing use, retention, or completion data (hereafter usage data or, for brevity, engagement) from implemented pure self-help (unguided) digital interventions for depression, anxiety, or the enhancement of mood. Methods: We conducted a systematic search of the Scopus, Embase, MEDLINE, and PsychINFO databases for studies reporting user uptake and/or usage data from implemented digital self-help interventions for the treatment or prevention of depression or anxiety, or the enhancement of mood, from 2002 to 2017. Additionally, we screened the reference lists of included articles, citations of these articles, and the titles of articles published in Internet Interventions, Journal of Medical Internet Research (JMIR), and JMIR Mental Health since their inception. We extracted data indicating the number of registrations or downloads and usage of interventions. Results: After the removal of duplicates, 970 papers were identified, of which 10 met the inclusion criteria. Hand searching identified 1 additional article. The included articles reported on 7 publicly available interventions. There was little consistency in the measures reported. The number of registrants or downloads ranged widely, from 8 to over 40,000 per month. From 21\% to 88\% of users engaged in at least minimal use (eg, used the intervention at least once or completed one module or assessment), whereas 7-42\% engaged in moderate use (completing between 40\% and 60\% of modular fixed-length programs or continuing to use apps after 4 weeks). Indications of completion or sustained use (completion of all modules or the last assessment or continuing to use apps after six weeks or more) varied from 0.5\% to 28.6\%. Conclusions: Available data suggest that uptake and engagement vary widely among the handful of implemented digital self-help apps and programs that have reported this, and that usage may vary from that reported in trials. Implementation data should be routinely gathered and reported to facilitate improved uptake and engagement, arguably among the major challenges in digital health. ",
doi="10.2196/jmir.9275",
url="http://www.jmir.org/2018/6/e199/"
}


@Article{info:doi/10.2196/jmir.9548,
author="Hopwood, Jenny
and Walker, Nina
and McDonagh, Lorraine
and Rait, Greta
and Walters, Kate
and Iliffe, Stephen
and Ross, Jamie
and Davies, Nathan",
title="Internet-Based Interventions Aimed at Supporting Family Caregivers of People With Dementia: Systematic Review",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="12",
volume="20",
number="6",
pages="e216",
keywords="dementia",
keywords="caregivers",
keywords="internet",
keywords="review",
abstract="Background: Caring for someone with dementia is one of the most challenging caring roles. The need for support for family caregivers has been recognized for some time but is often still lacking. With an aging population, demand on health and social care services is growing, and the population is increasingly looking to the internet for information and support. Objective: In this review, we aimed to (1) identify the key components of existing internet-based interventions designed to support family caregivers of people with dementia, (2) develop an understanding of which components are most valued by caregivers, and (3) consider the evidence of effectiveness of internet-based interventions designed to support family caregivers of people with dementia. Methods: We conducted a systematic search of online databases in April 2018. We searched reference lists and tracked citations. All study designs were included. We adopted a narrative synthesis approach with thematic analysis and tabulation as tools. Results: We identified 2325 studies, of which we included 40. The interventions varied in the number and types of components, duration and dose, and outcomes used to measure effectiveness. The interventions focused on (1) contact with health or social care providers, (2) peer interaction, (3) provision of information, (4) decision support, and (5) psychological support. The overall quality of the studies was low, making interpretation and generalizability of the effectiveness findings difficult. However, most studies suggested that interventions may be beneficial to family caregiver well-being, including positive impacts on depression, anxiety, and burden. Particular benefit came from psychological support provided online, where several small randomized controlled trials suggested improvements in caregiver mental health. Provision of information online was most beneficial when tailored specifically for the individual and used as part of a multicomponent intervention. Peer support provided in online groups was appreciated by most participants and showed positive effects on stress. Finally, online contact with a professional was appreciated by caregivers, who valued easy access to personalized practical advice and emotional support, leading to a reduction in burden and strain. Conclusions: Although mixed, the results indicate a positive response for the use of internet-based interventions by caregivers. More high-quality studies are required to identify the effectiveness of internet interventions aimed at supporting family caregivers, with particular focus on meeting the needs of caregivers during the different stages of dementia. ",
doi="10.2196/jmir.9548",
url="http://www.jmir.org/2018/6/e216/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29895512"
}


@Article{info:doi/10.2196/jmir.7053,
author="Schutte, Lisette
and Mevissen, E.F Fraukje
and Meijer, Suzanne
and Paulussen, Theo
and van Empelen, Pepijn
and Kok, Gerjo",
title="Effect Evaluation of a Web-Based Coaching Intervention to Support Implementation of Sex Education Among Secondary School Teachers: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="18",
volume="20",
number="6",
pages="e96",
keywords="sex education",
keywords="randomized controlled trial",
keywords="coaching",
keywords="secondary schools",
abstract="Background: The quality of implementation is important to ensure the effectiveness of behavioral change interventions in practice. Implementing such programs with completeness and adherence is not an automatic process and may require additional support. In school settings, the support teachers receive during implementation is often limited and appears to fall short when attempting to preserve completeness and adherence in program delivery. With the aim to improve completeness and adherence of teachers' delivery of a sexual health promoting intervention (``Long Live Love'' [LLL]) in secondary education, a Web-based e-coach was developed (``lesgevenindeliefde.nl''or``teachinglove.nl''). The effectiveness of the e-coach, as part of a broader implementation strategy, in influencing teachers' implementation was evaluated. Objective: This study aimed to report on the effect evaluation to determine the effect of the Web-based e-coach on teacher implementation of a school-based sex education program called LLL and on its determinants. Methods: A cluster randomized controlled trial (e-coaching vs waiting list control) was conducted with a baseline assessment (T0) and follow-up (T1) 2 weeks after completing the LLL program. A total of 43 schools with 83 teachers participated in the study. In the follow-up, 38 schools participated, 23 in the e-coaching condition with 41 teachers and 15 in the control condition with 26 teachers. Multilevel regression analysis was used to evaluate the effect of the e-coaching website on implementation behavior, namely, completeness and adherence to LLL implementation, and on its determinants. Results: The e-coaching intervention was not found to have an effect on teachers' implementation behavior; teachers assigned to the experimental e-coaching website did not score higher on completeness (P=.60) or adherence (P=.67) as compared with teachers in the control condition. When comparing the 30 teachers who made actual use of the e-coaching website with the 37 teachers who did not, no significant differences were found either (P?.54). In addition, there was no effect of e-coaching on the determinants of teacher implementation behavior (t67-75?0.69; P?.22). Conclusions: E-coaching was not found to be effective in enhancing completeness of and adherence to LLL by teachers. The lack of effect may be attributed to the intervention content, the limited use, or the study design itself. The e-coaching intervention may not have adequately addressed adherence and completeness of LLL to bring about behavioral change. Furthermore, the e-coaching intervention was not or insufficiently used by teachers. A possible biased sample of motivated, able teachers may have agreed to participate in the study, and a possible ``ceiling effect'' may have been present because of the high implementation grade. This, however, does not imply that Web-based coaching in itself is an ineffective strategy to promote adherence and completeness of program implementation. A process evaluation is required as follow-up. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN11754581; http://www.isrctn.com/ISRCTN11754581 (Archived by WebCite at http://www.webcitation.org/70C5TUOOh) ",
doi="10.2196/jmir.7053",
url="http://www.jmir.org/2018/6/e96/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29734139"
}


@Article{info:doi/10.2196/jmir.9387,
author="Weisel, Krueger Kiona
and Lehr, Dirk
and Heber, Elena
and Zarski, Anna-Carlotta
and Berking, Matthias
and Riper, Heleen
and Ebert, Daniel David",
title="Severely Burdened Individuals Do Not Need to Be Excluded From Internet-Based and Mobile-Based Stress Management: Effect Modifiers of Treatment Outcomes From Three Randomized Controlled Trials",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="19",
volume="20",
number="6",
pages="e211",
keywords="anxiety",
keywords="depression",
keywords="internet",
keywords="effect modifier",
keywords="randomized controlled trials",
keywords="occupational stress",
abstract="Background: Although internet-based and mobile-based stress management interventions (iSMIs) may be a promising strategy to reach employees suffering from high chronic stress, it remains unknown whether participants with high symptom severity of depression or anxiety also benefit from iSMIs or should be excluded. Objective: This study aimed to evaluate the efficacy of iSMIs in subgroups with high symptom severity and to test whether baseline symptom severity moderates treatment outcome. Methods: Data from three randomized controlled trials (N=791) were pooled to identify effect modifiers and to evaluate efficacy in subgroups with different levels of initial symptom severity. The outcomes perceived stress (Perceived Stress Scale, PSS), depression severity (Center for Epidemiological Depression Scale, CES-D), and anxiety (Hospital Anxiety and Depression Scale, HADS) symptom severity were assessed at baseline, 7-week postassessment, and 6-month follow-up. Potential moderators were tested in predicting differences in the change of outcome in multiple moderation analyses. Simple slope analyses evaluated efficacy of the iSMI comparing the intervention group with the waitlist control group in subgroups with low, moderate, and severe initial symptomology based on means and SDs of the study population. In addition, subgroups with clinical values of depression (CES-D?16) and anxiety (HADS?8) at baseline were explored, and response rates (RRs; 50\% symptom reduction) and symptom-free (SF) status (CES-D<16, HADS<8) were reported. Results: Individuals with high stress (PSS?30), depression (CES-D?33), anxiety (HADS?15), and emotional exhaustion (MBI?5.6) benefited significantly from the intervention with great reductions of stress (dpost=0.86-1.16, dFU=0.93-1.35), depression (dpost=0.69-1.08, dFU=0.91-1.19), and anxiety (dpost=0.79-1.19, dFU=1.06-1.21), and effects were sustained at 6-month follow-up. Symptom severity moderated treatment outcomes, as individuals with higher symptom severity at baseline benefited significantly more from the intervention than individuals with lower symptom severity. Furthermore, 82.9\% (656/791) of individuals had clinical depression values at baseline, of which significantly more individuals in the intervention group reached at least 50\% symptom reduction or fell under clinical cut-off (RR: 29.2\%, 93/318; SF: 39.6\%, 126/318) compared with the waitlist control group (RR: 8.0\%, 27/338; SF: 18.6\%, 63/338) at postassessment. Significantly more individuals with clinical anxiety values at baseline (HADS?8, 85.3\%, 675/791) in the intervention group achieved at least 50\% symptom reduction or fell under clinical cut-off (RR: 27.7\%, 94/339; SF: 39.8\%, 135/339) compared with the WLC (RR: 4.8\%, 16/336; SF: 15.5\%, 52/336). Conclusions: Highly burdened individuals benefit greatly from iSMIs and therefore should not be excluded from participation. Stress management may be a valid entry point to reach highly burdened individuals who otherwise may not seek treatment. Trial Registration: 1) German Clinical Trials Register DRKS00005112; https://www.drks.de/DRKS00005112 (Archived by WebCite at http://www.webcitation.org/6zmIZwvdA); 2) German Clinical Trials Register DRKS00005384; https://www.drks.de/ DRKS00005384 (Archived by WebCite at http://www.webcitation.org/6zmIerdtr); and 3) German Clinical Trials Register DRKS00004749; https://www.drks.de/DRKS00004749 (Archived by WebCite at http://www.webcitation.org/6zmIjDQPx). ",
doi="10.2196/jmir.9387",
url="http://www.jmir.org/2018/6/e211/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29921562"
}


@Article{info:doi/10.2196/jmir.9555,
author="Chakraborty, Bibhas
and Maiti, Raju
and Strecher, J. Victor",
title="The Effectiveness of Web-Based Tailored Smoking Cessation Interventions on the Quitting Process (Project Quit): Secondary Analysis of a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="20",
volume="20",
number="6",
pages="e213",
keywords="smoking cessation",
keywords="number of quit attempts",
keywords="tailored intervention",
keywords="treatment regimen",
keywords="Web-based intervention",
abstract="Background: Project Quit was a randomized Web-based smoking cessation trial designed and conducted by researchers from the University of Michigan, where its primary outcome was the 7-day point prevalence. One drawback of such an outcome is that it only focuses on smoking behavior over a very short duration, rather than the quitting process over the entire study period. Objective: The aim of this study was to consider the number of quit attempts during the 6-month study period as an alternative outcome, which would better reflect the quitting process. We aimed to find out whether tailored interventions (high vs low) are better in reducing the number of quit attempts for specific subgroups of smokers. Methods: To identify interactions between intervention components of smoking cessation and individual smoker characteristics, we employed Poisson regression to analyze the number of quit attempts. This approach allowed us to construct data-driven, personalized interventions. Results: A negative effect of the number of cigarettes smoked per day (P=.03) and a positive effect of education (P=.03) on the number of quit attempts were detected from the baseline covariates (n=792). Thus, for every 10 extra cigarettes smoked per day, there was a 5.84\% decrease in the expected number of quit attempts. Highly educated participants had a 15.49\% increase in their expected number of quit attempts compared with their low-educated counterparts. A negative interaction between intervention component story and smoker's education was also detected (P=.03), suggesting that a high-tailored story given to highly educated people results in 13.50\% decrease in the number of quit attempts compared with a low-tailored story. Conclusions: A highly individually tailored story is significantly more effective for smokers with a low level of education. This is consistent with prior findings from Project Quit based on the 7-day point prevalence. ",
doi="10.2196/jmir.9555",
url="http://www.jmir.org/2018/6/e213/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29925494"
}


@Article{info:doi/10.2196/10457,
author="Srikesavan, Cynthia
and Williamson, Esther
and Cranston, Tim
and Hunter, John
and Adams, Jo
and Lamb, E. Sarah",
title="An Online Hand Exercise Intervention for Adults With Rheumatoid Arthritis (mySARAH): Design, Development, and Usability Testing",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="27",
volume="20",
number="6",
pages="e10457",
keywords="rheumatoid arthritis",
keywords="hand joints",
keywords="exercise training",
keywords="web-based",
abstract="Background: The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) program is a tailored, progressive 12-week exercise program for people with hand problems due to rheumatoid arthritis. The program was shown to be clinically and cost-effective in a large clinical trial and is recommended by the UK National Institute for Health and Care Excellence (NICE) guidelines for rheumatoid arthritis in adults. Objective: We have developed an online version of the SARAH program (mySARAH) to make the SARAH program widely accessible to people with rheumatoid arthritis. The purposes of this study were to develop mySARAH and to evaluate and address its usability issues. Methods: We developed mySARAH using a three-step process and gaining feedback from patient contributors. After initial development, mySARAH was tested in two iterative usability cycles in nine participants using a simplified think-aloud protocol and self-reported questionnaires. We also evaluated if participants executed the SARAH exercises correctly after watching the exercise videos included on the website. Results: A preliminary version of mySARAH consisting of six sessions over a 12-week period and delivered via text, exercise videos, images, exercise plan form, exercise calendar, and links to additional information on rheumatoid arthritis was developed. Five participants (1 male; 4 females; median age 64 years) and four participants (four females; median age 64.5 years) took part in the first and second usability testing cycles respectively. Usability issues identified from Cycle 1 such as having a navigation tutorial video and individualised feedback on pain levels were addressed prior to Cycle 2. The need for more instructions to complete the mySARAH patient forms was identified in Cycle 2 and was rectified. Self-reports from both cycles indicated that participants found the program useful and easy to use and were confident in performing the SARAH exercises themselves. Eight of the nine participants correctly demonstrated all the exercises. Conclusions: mySARAH is the first online hand exercise intervention for people with rheumatoid arthritis. We actively involved target users in the development and usability evaluation and ensured mySARAH met their needs and preferences. ",
doi="10.2196/10457",
url="http://www.jmir.org/2018/6/e10457/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29950288"
}


@Article{info:doi/10.2196/10484,
author="Duggleby, Wendy
and Ploeg, Jenny
and McAiney, Carrie
and Peacock, Shelley
and Fisher, Kathryn
and Ghosh, Sunita
and Markle-Reid, Maureen
and Swindle, Jennifer
and Williams, Allison
and Triscott, AC Jean
and Forbes, Dorothy
and Jovel Ruiz, Kathya",
title="Web-Based Intervention for Family Carers of Persons with Dementia and Multiple Chronic Conditions (My Tools 4 Care): Pragmatic Randomized Controlled Trial",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="29",
volume="20",
number="6",
pages="e10484",
keywords="carers",
keywords="dementia",
keywords="treatment",
keywords="internet",
abstract="Background: My Tools 4 Care (MT4C) is a Web-based intervention that was developed based on the transitions theory. It is an interactive, self-administered, and portable toolkit containing six main sections intended to support carers of community-living persons with Alzheimer's disease and related dementia and multiple chronic conditions through their transition experiences. Objective: The objective of our study was to evaluate the effectiveness of MT4C with respect to increasing hope, self-efficacy, and health-related quality of life in carers of community-living older persons with Alzheimer's disease and related dementia and multiple chronic conditions. Methods: A multisite, pragmatic, mixed methods, longitudinal, repeated-measures, randomized controlled trial was conducted between June 2015 and April 2017. Eligible participants were randomized into either treatment (MT4C) or educational control groups. Following baseline measures, carers in the treatment group received 3 months of password-protected access to MT4C. Trained research assistants collected data from participants via phone on hope (Herth Hope Index [HHI]), self-efficacy (General Self-Efficacy Scale), and health-related quality of life (Short Form-12 item [version 2] health survey; SF-12v2) at baseline, 1, 3, and 6 months. The use and cost of health and social services (Health and Social Services Utilization Inventory) among participants were measured at baseline, 3, and 6 months. Analysis of covariance was used to identify group differences at 3 months, and generalized estimating equations were used to identify group differences over time. Results: A total of 199 carers participated in this study, with 101 participants in the treatment group and 98 in the educational control group. Of all, 23\% (45/199) participants withdrew during the study for various reasons, including institutionalization or death of the person with dementia and lack of time from the carer. In the treatment group, 73\% (74/101) carers used MT4C at least once over the 3-month period. No significant differences in the primary outcome measure (mental component summary score from the SF-12v2) by group or time were noted at 3 months; however, significant differences were evident for HHI-factor 2 (P=.01), with higher hope scores in the treatment group than in the control group. General estimating equations showed no statistically significant group differences in terms of mental component summary score at all time points. Attrition and the fact that not all carers in the treatment group used MT4C may explain the absence of statistically significant results for the main outcome variable. Conclusions: Despite no significant differences between groups in terms of the primary outcome variable (mental component score), the significant differences in terms of one of the hope factors suggest that MT4C had a positive influence on the lives of participants. Trial Registration: ClinicalTrials.gov NCT02428387; https://clinicaltrials.gov/ct2/show/NCT02428387 (Archived by Webcite at http://www.webcitation.org/708oFCR8h). ",
doi="10.2196/10484",
url="http://www.jmir.org/2018/6/e10484/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29959111"
}


@Article{info:doi/10.2196/jmir.9410,
author="Sano, Akane
and Taylor, Sara
and McHill, W. Andrew
and Phillips, JK Andrew
and Barger, K. Laura
and Klerman, Elizabeth
and Picard, Rosalind",
title="Identifying Objective Physiological Markers and Modifiable Behaviors for Self-Reported Stress and Mental Health Status Using Wearable Sensors and Mobile Phones: Observational Study",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="08",
volume="20",
number="6",
pages="e210",
keywords="mobile health",
keywords="mood",
keywords="machine learning",
keywords="wearable electronic devices",
keywords="smartphone",
keywords="mobile phone",
keywords="mental health",
keywords="psychological stress",
abstract="Background: Wearable and mobile devices that capture multimodal data have the potential to identify risk factors for high stress and poor mental health and to provide information to improve health and well-being. Objective: We developed new tools that provide objective physiological and behavioral measures using wearable sensors and mobile phones, together with methods that improve their data integrity. The aim of this study was to examine, using machine learning, how accurately these measures could identify conditions of self-reported high stress and poor mental health and which of the underlying modalities and measures were most accurate in identifying those conditions. Methods: We designed and conducted the 1-month SNAPSHOT study that investigated how daily behaviors and social networks influence self-reported stress, mood, and other health or well-being-related factors. We collected over 145,000 hours of data from 201 college students (age: 18-25 years, male:female=1.8:1) at one university, all recruited within self-identified social groups. Each student filled out standardized pre- and postquestionnaires on stress and mental health; during the month, each student completed twice-daily electronic diaries (e-diaries), wore two wrist-based sensors that recorded continuous physical activity and autonomic physiology, and installed an app on their mobile phone that recorded phone usage and geolocation patterns. We developed tools to make data collection more efficient, including data-check systems for sensor and mobile phone data and an e-diary administrative module for study investigators to locate possible errors in the e-diaries and communicate with participants to correct their entries promptly, which reduced the time taken to clean e-diary data by 69\%. We constructed features and applied machine learning to the multimodal data to identify factors associated with self-reported poststudy stress and mental health, including behaviors that can be possibly modified by the individual to improve these measures. Results: We identified the physiological sensor, phone, mobility, and modifiable behavior features that were best predictors for stress and mental health classification. In general, wearable sensor features showed better classification performance than mobile phone or modifiable behavior features. Wearable sensor features, including skin conductance and temperature, reached 78.3\% (148/189) accuracy for classifying students into high or low stress groups and 87\% (41/47) accuracy for classifying high or low mental health groups. Modifiable behavior features, including number of naps, studying duration, calls, mobility patterns, and phone-screen-on time, reached 73.5\% (139/189) accuracy for stress classification and 79\% (37/47) accuracy for mental health classification. Conclusions: New semiautomated tools improved the efficiency of long-term ambulatory data collection from wearable and mobile devices. Applying machine learning to the resulting data revealed a set of both objective features and modifiable behavioral features that could classify self-reported high or low stress and mental health groups in a college student population better than previous studies and showed new insights into digital phenotyping. ",
doi="10.2196/jmir.9410",
url="http://www.jmir.org/2018/6/e210/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29884610"
}


@Article{info:doi/10.2196/10528,
author="Spring, Bonnie
and Pellegrini, Christine
and McFadden, G. H.
and Pfammatter, Fidler Angela
and Stump, K. Tammy
and Siddique, Juned
and King, C. Abby
and Hedeker, Donald",
title="Multicomponent mHealth Intervention for Large, Sustained Change in Multiple Diet and Activity Risk Behaviors: The Make Better Choices 2 Randomized Controlled Trial",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="19",
volume="20",
number="6",
pages="e10528",
keywords="health behavior",
keywords="risk factors",
keywords="mobile health",
keywords="behavioral medicine",
keywords="randomized controlled trial",
abstract="Background: Prevalent co-occurring poor diet and physical inactivity convey chronic disease risk to the population. Large magnitude behavior change can improve behaviors to recommended levels, but multiple behavior change interventions produce small, poorly maintained effects. Objective: The Make Better Choices 2 trial tested whether a multicomponent intervention integrating mHealth, modest incentives, and remote coaching could sustainably improve diet and activity. Methods: Between 2012 and 2014, the 9-month randomized controlled trial enrolled 212 Chicago area adults with low fruit and vegetable and high saturated fat intakes, low moderate to vigorous physical activity (MVPA) and high sedentary leisure screen time. Participants were recruited by advertisements to an open-access website, screened, and randomly assigned to either of two active interventions targeting MVPA simultaneously with, or sequentially after other diet and activity targets (N=84 per intervention) or a stress and sleep contact control intervention (N=44). They used a smartphone app and accelerometer to track targeted behaviors and received personalized remote coaching from trained paraprofessionals. Perfect behavioral adherence was rewarded with an incentive of US \$5 per week for 12 weeks. Diet and activity behaviors were measured at baseline, 3, 6, and 9 months; primary outcome was 9-month diet and activity composite improvement. Results: Both simultaneous and sequential interventions produced large, sustained improvements exceeding control (P<.001), and brought all diet and activity behaviors to guideline levels. At 9 months, the interventions increased fruits and vegetables by 6.5 servings per day (95\% CI 6.1-6.8), increased MVPA by 24.7 minutes per day (95\% CI 20.0-29.5), decreased sedentary leisure by 170.5 minutes per day (95\% CI --183.5 to --157.5), and decreased saturated fat intake by 3.6\% (95\% CI --4.1 to --3.1). Retention through 9-month follow-up was 82.1\%. Self-monitoring decreased from 96.3\% of days at baseline to 72.3\% at 3 months, 63.5\% at 6 months, and 54.6\% at 9 months (P<.001). Neither attrition nor decline in self-monitoring differed across intervention groups. Conclusions: Multicomponent mHealth diet and activity intervention involving connected coaching and modest initial performance incentives holds potential to reduce chronic disease risk. Trial Registration: ClinicalTrials.gov NCT01249989; https://clinicaltrials.gov/ct2/show/NCT01249989 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT01249989). ",
doi="10.2196/10528",
url="http://www.jmir.org/2018/6/e10528/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29921561"
}


@Article{info:doi/10.2196/10227,
author="Klassen, Michelle Karen
and Borleis, S. Emily
and Brennan, Linda
and Reid, Mike
and McCaffrey, A. Tracy
and Lim, SC Megan",
title="What People ``Like'': Analysis of Social Media Strategies Used by Food Industry Brands, Lifestyle Brands, and Health Promotion Organizations on Facebook and Instagram",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="14",
volume="20",
number="6",
pages="e10227",
keywords="nutrition",
keywords="social media",
keywords="Facebook",
keywords="Instagram",
keywords="health promotion",
abstract="Background: Health campaigns have struggled to gain traction with young adults using social media, even though more than 80\% of young adults are using social media at least once per day. Many food industry and lifestyle brands have been successful in achieving high levels of user engagement and promoting their messages; therefore, there may be lessons to be learned by examining the successful strategies commercial brands employ. Objective: This study aims to identify and quantify social media strategies used by the food industry and lifestyle brands, and health promotion organizations across the social networking sites Facebook and Instagram. Methods: The six most engaging posts from the 10 most popular food industry and lifestyle brands and six health promotion organizations were included in this study. A coding framework was developed to categorize social media strategies, and engagement metrics were collected. Exploratory linear regression models were used to examine associations between strategies used and interactions on Facebook and Instagram. Results: Posts from Facebook (143/227, 63.0\%) and Instagram (84/227, 37.0\%) were included. Photos (64\%) and videos (34\%) were used to enhance most posts. Different strategies were most effective for Facebook and Instagram. Strategies associated with higher Facebook interactions included links to purchasable items (beta=0.81, 95\% CI 0.50 to 1.13, P<.001) featuring body image messages compared with food content (beta=1.96, 95\% CI 1.29 to 2.64, P<.001), and where the content induced positive emotions (beta=0.31, 95\% CI 0.04 to 0.57, P=.02). Facebook interactions were negatively associated with using pop culture (beta=--0.67, 95\% CI --0.99 to --0.34, P<.001), storytelling (beta=--0.86, 95\% CI --1.29 to --0.43, P<.001) or visually appealing graphics (beta=--0.53, 95\% CI --0.78 to --0.28, P<.001) in their posts compared with other strategies. Posting relatable content was negatively associated with interactions on Facebook (beta=--0.29, 95\% CI --0.53 to --0.06, P=.01), but positively associated on Instagram (beta=0.50, 95\% CI 0.05 to 0.95, P=.03). Instagram interactions were negatively associated with weight loss (beta=--1.45, 95\% CI --2.69 to --0.21, P=.02) and other content (beta=--0.81, 95\% CI --1.57 to --.06, P=.04) compared with food content. Conclusions: Health promotion professionals and organizations can improve engagement using positive messaging and tailoring posts appropriate for different social media channels. ",
doi="10.2196/10227",
url="http://www.jmir.org/2018/6/e10227/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29903694"
}


@Article{info:doi/10.2196/jmir.9355,
author="Hendriks, Hanneke
and Van den Putte, Bas
and Gebhardt, A. Winifred
and Moreno, A. Megan",
title="Social Drinking on Social Media: Content Analysis of the Social Aspects of Alcohol-Related Posts on Facebook and Instagram",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="22",
volume="20",
number="6",
pages="e226",
keywords="social media",
keywords="alcohol drinking",
keywords="social interaction",
abstract="Background: Alcohol is often consumed in social contexts. An emerging social context in which alcohol is becoming increasingly apparent is social media. More and more young people display alcohol-related posts on social networking sites such as Facebook and Instagram. Objective: Considering the importance of the social aspects of alcohol consumption and social media use, this study investigated the social content of alcohol posts (ie, the evaluative social context and presence of people) and social processes (ie, the posting of and reactions to posts) involved with alcohol posts on social networking sites. Methods: Participants (N=192; mean age 20.64, SD 4.68 years, 132 women and 54 men) gave researchers access to their Facebook and/or Instagram profiles, and an extensive content analysis of these profiles was conducted. Coders were trained and then coded all screenshotted timelines in terms of evaluative social context, presence of people, and reactions to post. Results: Alcohol posts of youth frequently depict alcohol in a positive social context (425/438, 97.0\%) and display people holding drinks (277/412, 67.2\%). In addition, alcohol posts were more often placed on participants' timelines by others (tagging; 238/439, 54.2\%) than posted by participants themselves (201/439, 45.8\%). Furthermore, it was revealed that such social posts received more likes (mean 35.50, SD 26.39) and comments than nonsocial posts (no people visible; mean 10.34, SD 13.19, P<.001). Conclusions: In terms of content and processes, alcohol posts on social media are social in nature and a part of young people's everyday social lives. Interventions aiming to decrease alcohol posts should therefore focus on the broad social context of individuals in which posting about alcohol takes place. Potential intervention strategies could involve making young people aware that when they post about social gatherings in which alcohol is visible and tag others, it may have unintended negative consequences and should be avoided. ",
doi="10.2196/jmir.9355",
url="http://www.jmir.org/2018/6/e226/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29934290"
}


@Article{info:doi/10.2196/jmir.9156,
author="Easton, Stephanie
and Morton, Katherine
and Tappy, Zara
and Francis, Daniella
and Dennison, Laura",
title="Young People's Experiences of Viewing the Fitspiration Social Media Trend: Qualitative Study",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="18",
volume="20",
number="6",
pages="e219",
keywords="Social media",
keywords="Fitspiration",
keywords="behaviour",
keywords="health",
keywords="body image",
keywords="self-esteem",
keywords="eating disorders",
keywords="qualitative research",
keywords="focus groups",
keywords="interviews",
abstract="Background: Social media use has become ubiquitous in the lives of many people, especially young adults. A popular recent trend emerging on social media is that of posting and following `Fitspirational' content - material that purports to motivate and showcase healthy lifestyle habits, particularly relating to exercise and diet. There is very limited existing literature on how engaging with this type of content influences people's psychological and physical heath. Initial studies have focused on concerns over potential negative effects on psychological wellbeing including body image, self-esteem and eating disorders. Objective: We aimed to address a gap in the literature for exploratory research on this topic from the perspective of users. We used a qualitative approach to explore how people experience viewing Fitspiration on social media including why and how they engage with this material and how they perceive that it affects their thoughts, emotions, behaviour and health. Methods: We recruited 20 young adults (14 females, 6 males, aged 18-25) who self-declared themselves to be Fitspiration followers to participate in either focus groups or individual interviews. We asked detailed, open-ended questions about their motivations for following Fitspiration, experiences of viewing this content and its perceived impact. We used inductive thematic analysis to derive themes that represented common and salient features of the data set. Results: Four main themes were developed: 1) A tool with the potential to support healthy living, 2) Unrealistic, untrustworthy content, 3) Negative effects on emotional wellbeing, and 4) Vulnerability and protective factors. Following Fitspirational posts on social media can provide young people with knowledge and motivation that may support healthy lifestyle behaviours. However, a range of harms also appeared to arise from Fitspiration viewing ranging from minor annoyances and frustrations to more meaningful negative effects on psychological \& physical health. These negative effects seemed to persist despite individuals acknowledging that the material can be unrealistic, and believing that they are personally equipped to minimise harms to themselves. Conclusions: This study suggests that Fitspiration on social media can be attractive and compelling for young people but appears to bring about negative as well as positive effects. Future research should aim to confirm the scale and intensity of positive and negative effects and investigate ways of harnessing desirable outcomes and minimising undesirable outcomes. ",
doi="10.2196/jmir.9156",
url="http://www.jmir.org/2018/6/e219/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29914859"
}


@Article{info:doi/10.2196/jmir.9461,
author="Guillory, Jamie
and Wiant, F. Kristine
and Farrelly, Matthew
and Fiacco, Leah
and Alam, Ishrat
and Hoffman, Leah
and Crankshaw, Erik
and Delahanty, Janine
and Alexander, N. Tesfa",
title="Recruiting Hard-to-Reach Populations for Survey Research: Using Facebook and Instagram Advertisements and In-Person Intercept in LGBT Bars and Nightclubs to Recruit LGBT Young Adults",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="18",
volume="20",
number="6",
pages="e197",
keywords="sexual minorities",
keywords="social media",
keywords="public health",
keywords="tobacco",
keywords="survey methods",
keywords="transgender persons",
abstract="Background: Tobacco public education campaigns focus increasingly on hard-to-reach populations at higher risk for smoking, prompting campaign creators and evaluators to develop strategies to reach hard-to-reach populations in virtual and physical spaces where they spend time. Objective: The aim of this study was to describe two novel recruitment strategies (in-person intercept interviews in lesbian, gay, bisexual, and transgender [LGBT] social venues and targeted social media ads) and compares characteristics of participants recruited via these strategies for the US Food and Drug Administration's This Free Life campaign evaluation targeting LGBT young adults who smoke cigarettes occasionally. Methods: We recruited LGBT adults aged 18-24 years in the United States via Facebook and Instagram ads (N=1709, mean age 20.94, SD 1.94) or intercept in LGBT social venues (N=2348, mean age 21.98, SD 1.69) for the baseline evaluation survey. Covariates related to recruitment strategy were age; race or ethnicity; LGBT identity; education; pride event attendance; and alcohol, cigarette, and social media use. Results: Lesbian or gay women (adjusted odds ratio, AOR 1.88, 95\% CI 1.54-2.29, P<.001), bisexual men and women (AOR 1.46, 95\% CI 1.17-1.82, P=.001), gender minorities (AOR 1.68, 95\% CI 1.26-2.25, P<.001), and other sexual minorities (AOR 2.48, 95\% CI 1.62-3.80, P<.001) were more likely than gay men to be recruited via social media (than intercept). Hispanic (AOR 0.73, 95\% CI 0.61-0.89, P=.001) and other or multiracial, non-Hispanic participants (AOR 0.70, 95\% CI 0.54-0.90, P=.006) were less likely than white, non-Hispanic participants to be recruited via social media. As age increased, odds of recruitment via social media decreased (AOR 0.76, 95\% CI 0.72-0.80, P<.001). Participants with some college education (AOR 1.27, 95\% CI 1.03-1.56, P=.03) were more likely than those with a college degree to be recruited via social media. Participants reporting past 30-day alcohol use were less likely to be recruited via social media (AOR 0.33, 95\% CI 0.24-0.44, P<.001). Participants who reported past-year pride event attendance were more likely to be recruited via social media (AOR 1.31, 95\% CI 1.06-1.64, P=.02), as well as those who used Facebook at least once daily (AOR 1.43, 95\% CI 1.14-1.80, P=.002). Participants who reported using Instagram at least once daily were less likely to be recruited via social media (AOR 0.73, 95\% CI 0.62-0.86, P<.001). Social media recruitment was faster (incidence rate ratio, IRR=3.31, 95\% CI 3.11-3.52, P<.001) and less expensive (2.2\% of combined social media and intercept recruitment cost) but had greater data quality issues---a larger percentage of social media respondents were lost because of duplicate and low-quality responses (374/4446, 8.41\%) compared with intercept respondents lost to interviewer misrepresentation (15/4446, 0.34\%; P<.001). Conclusions: Social media combined with intercept provided access to important LGBT subpopulations (eg, gender and other sexual minorities) and a more diverse sample. Social media methods have more data quality issues but are faster and less expensive than intercept. Recruiting hard-to-reach populations via audience-tailored strategies enabled recruitment of one of the largest LGBT young adult samples, suggesting these methods' promise for accessing hard-to-reach populations. ",
doi="10.2196/jmir.9461",
url="http://www.jmir.org/2018/6/e197/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29914861"
}


@Article{info:doi/10.2196/10109,
author="Parmar, Nilesh
and Dong, Lin
and Eisingerich, Benedikt Andreas",
title="Connecting With Your Dentist on Facebook: Patients' and Dentists' Attitudes Towards Social Media Usage in Dentistry",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="29",
volume="20",
number="6",
pages="e10109",
keywords="social media, medical communication, dental practices, dental anxiety, Facebook, Twitter",
abstract="Background: Social media has begun to proliferate across medical areas and transformed how medical professionals serve and interact with their patients. It offers a new communication avenue that has the potential to engage patients and, hence, may be used to create value for both medical professionals and patients. In dentistry, even though patients and dentists frequently use social media in their personal lives, little is known about their attitudes and expectations toward using social media for professional interactions. Objective: In this paper, we focus on the role of social media in dentistry. Specifically, we explore patients' and dentists' attitudes toward social media usage and their current online behaviors in this context. Furthermore, we examine potential challenges and opportunities regarding dentists' adoption of social media practices. Methods: This research employed a large-scale online survey of 588 patients and 532 dental professionals. We assessed the attitudes, expectations, and social media behaviors from both patients' and dentists' perspectives. Results: We found that more than 55\% (290/532) of dentists in our sample have accounts for their dental practice on various social media platforms. Interestingly, while 73\% (374/511) of patients did not expect their dental practice to have a social media presence, and 44\% (207/468) thought that establishing a friendship with their dentists is not appropriate, the findings show that 36\% (164/460) of patients had searched for their dentists, and 44\% (207/470) of them were happy to establish contacts with dentists on social media. Furthermore, the findings highlight that patients were interested in exploring additional information such as online reviews and the qualifications of their dentists on Facebook pages. For dentists, more than half (375/432, 83\%) of them in our sample thought that social media marketing is more efficient compared to traditional marketing. Conclusions: Our findings revealed some key challenges and opportunities to utilize social media in dentistry. For both patients and dentists, the role of social media in dental services remains vague, and both parties still share concerns about connecting with each other on social media platforms. However, there also exists a sizeable number of patients who are already comfortable to connect with their dentists on social media sites such as Facebook. The current findings show that there is an opportunity for dental practices to trade upon a more active social media presence for enhanced patient interaction and engagement. ",
doi="10.2196/10109",
url="http://www.jmir.org/2018/6/e10109/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29959108"
}


@Article{info:doi/10.2196/10386,
author="O'Connor, Marianne
and Morgan, E. Katy
and Bailey-Straebler, Suzanne
and Fairburn, G. Christopher
and Cooper, Zafra",
title="Increasing the Availability of Psychological Treatments: A Multinational Study of a Scalable Method for Training Therapists",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="08",
volume="20",
number="6",
pages="e10386",
keywords="internet",
keywords="web-centered",
keywords="eating disorders",
keywords="cognitive therapy",
keywords="effective treatment",
abstract="Background: One of the major barriers to the dissemination and implementation of psychological treatments is the scarcity of suitably trained therapists. A highly scalable form of Web-centered therapist training, undertaken without external support, has recently been shown to have promise in promoting therapist competence. Objective: The aim of this study was to conduct an evaluation of the acceptability and effectiveness of a scalable independent form of Web-centered training in a multinational sample of therapists and investigate the characteristics of those most likely to benefit. Methods: A cohort of eligible therapists was recruited internationally and offered access to Web-centered training in enhanced cognitive behavioral therapy, a multicomponent, evidence-based, psychological treatment for any form of eating disorder. No external support was provided during training. Therapist competence was assessed using a validated competence measure before training and after 20 weeks. Results: A total of 806 therapists from 33 different countries expressed interest in the study, and 765 (94.9\%) completed a pretraining assessment. The median number of training modules completed was 15 out of a possible 18 (interquartile range, IQR: 4-18), and 87.9\% (531/604) reported that they treated at least one patient during training as recommended. Median pretraining competence score was 7 (IQR: 5-10, range: 0-19; N=765), and following training, it was 12 (IQR: 9-15, range: 0-20; N=577). The expected change in competence scores from pretraining to posttraining was 3.5 (95\% CI 3.1-3.8; P<.001). After training, 52\% (300/574) of therapists with complete competence data met or exceeded the competence threshold, and 45\% (95\% CI 41-50) of those who had not met this threshold before training did so after training. Compliance with training predicted both an increase in competence scores and meeting or exceeding the competence threshold. Expected change in competence score increased for each extra training module completed (0.19, 95\% CI 0.13-0.25), and those who treated a suitable patient during training had an expected change in competence score 1.2 (95\% CI 0.4-2.1) points higher than those who did not. Similarly, there was an association between meeting the competence threshold after training and the number of modules completed (odds ratio, OR=1.11, 95\% CI 1.07-1.15), and treating at least one patient during training was associated with competence after training (OR=2.2, 95\% CI 1.2-4.1). Conclusions: Independent Web-centered training can successfully train large numbers of therapists dispersed across a wide geographical area. This finding is of importance because the availability of a highly scalable method of training potentially increases the number of people who might receive effective psychological treatments. ",
doi="10.2196/10386",
url="http://www.jmir.org/2018/6/e10386/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29884606"
}


@Article{info:doi/10.2196/jmir.9870,
author="Keller, Sophie Michelle
and Mosadeghi, Sasan
and Cohen, R. Erica
and Kwan, James
and Spiegel, Ross Brennan Mason",
title="Reproductive Health and Medication Concerns for Patients With Inflammatory Bowel Disease: Thematic and Quantitative Analysis Using Social Listening",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="11",
volume="20",
number="6",
pages="e206",
keywords="pregnancy",
keywords="breastfeeding",
keywords="reproductive health",
keywords="social media",
keywords="medication adherence",
keywords="infodemiology",
keywords="pharmacovigilance",
abstract="Background: Inflammatory bowel disease (IBD) affects many individuals of reproductive age. Most IBD medications are safe to use during pregnancy and breastfeeding; however, observational studies find that women with IBD have higher rates of voluntary childlessness due to fears about medication use during pregnancy. Understanding why and how individuals with IBD make decisions about medication adherence during important reproductive periods can help clinicians address patient fears about medication use. Objective: The objective of this study was to gain a more thorough understanding of how individuals taking IBD medications during key reproductive periods make decisions about their medication use. Methods: We collected posts from 3000 social media sites posted over a 3-year period and analyzed the posts using qualitative descriptive content analysis. The first level of analysis, open coding, identified individual concepts present in the social media posts. We subsequently created a codebook from significant or frequently occurring codes in the data. After creating the codebook, we reviewed the data and coded using our focused codes. We organized the focused codes into larger thematic categories. Results: We identified 7 main themes in 1818 social media posts. Individuals used social media to (1) seek advice about medication use related to reproductive health (13.92\%, 252/1818); (2) express beliefs about the safety of IBD therapies (7.43\%, 135/1818); (3) discuss personal experiences with medication use (16.72\%, 304/1818); (4) articulate fears and anxieties about the safety of IBD therapies (11.55\%, 210/1818); (5) discuss physician-patient relationships (3.14\%, 57/1818); (6) address concerns around conception, infertility, and IBD medications (17.38\%, 316/1818); and (7) talk about IBD symptoms during and after pregnancy and breastfeeding periods (11.33\%, 206/1818). Conclusions: Beliefs around medication safety play an important role in whether individuals with IBD decide to take medications during pregnancy and breastfeeding. Having a better understanding about why patients stop or refuse to take certain medications during key reproductive periods may allow clinicians to address specific beliefs and attitudes during office visits. ",
doi="10.2196/jmir.9870",
url="http://www.jmir.org/2018/6/e206/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29891471"
}


@Article{info:doi/10.2196/jmir.9262,
author="van den Heuvel, FM Josephus
and Groenhof, Katrien T.
and Veerbeek, HW Jan
and van Solinge, W. Wouter
and Lely, Titia A.
and Franx, Arie
and Bekker, N. Mireille",
title="eHealth as the Next-Generation Perinatal Care: An Overview of the Literature",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="05",
volume="20",
number="6",
pages="e202",
keywords="pregnancy",
keywords="eHealth",
keywords="telemedicine",
keywords="pregnancy complications",
keywords="fetal monitoring",
keywords="patient-centered care",
keywords="pregnancy, high risk",
keywords="diabetes, gestational",
keywords="remote consultation",
keywords="ambulatory monitoring",
keywords="obstetrics",
keywords="perinatal care",
keywords="antenatal care",
abstract="Background: Unrestricted by time and place, electronic health (eHealth) provides solutions for patient empowerment and value-based health care. Women in the reproductive age are particularly frequent users of internet, social media, and smartphone apps. Therefore, the pregnant patient seems to be a prime candidate for eHealth-supported health care with telemedicine for fetal and maternal conditions. Objective: This study aims to review the current literature on eHealth developments in pregnancy to assess this new generation of perinatal care. Methods: We conducted a systematic literature search of studies on eHealth technology in perinatal care in PubMed and EMBASE in June 2017. Studies reporting the use of eHealth during prenatal, perinatal, and postnatal care were included. Given the heterogeneity in study methods, used technologies, and outcome measurements, results were analyzed and presented in a narrative overview of the literature. Results: The literature search provided 71 studies of interest. These studies were categorized in 6 domains: information and eHealth use, lifestyle (gestational weight gain, exercise, and smoking cessation), gestational diabetes, mental health, low- and middle-income countries, and telemonitoring and teleconsulting. Most studies in gestational diabetes and mental health show that eHealth applications are good alternatives to standard practice. Examples are interactive blood glucose management with remote care using smartphones, telephone screening for postnatal depression, and Web-based cognitive behavioral therapy. Apps and exercise programs show a direction toward less gestational weight gain, increase in step count, and increase in smoking abstinence. Multiple studies describe novel systems to enable home fetal monitoring with cardiotocography and uterine activity. However, only few studies assess outcomes in terms of fetal monitoring safety and efficacy in high-risk pregnancy. Patients and clinicians report good overall satisfaction with new strategies that enable the shift from hospital-centered to patient-centered care. Conclusions: This review showed that eHealth interventions have a very broad, multilevel field of application focused on perinatal care in all its aspects. Most of the reviewed 71 articles were published after 2013, suggesting this novel type of care is an important topic of clinical and scientific relevance. Despite the promising preliminary results as presented, we accentuate the need for evidence for health outcomes, patient satisfaction, and the impact on costs of the possibilities of eHealth interventions in perinatal care. In general, the combination of increased patient empowerment and home pregnancy care could lead to more satisfaction and efficiency. Despite the challenges of privacy, liability, and costs, eHealth is very likely to disperse globally in the next decade, and it has the potential to deliver a revolution in perinatal care. ",
doi="10.2196/jmir.9262",
url="http://www.jmir.org/2018/6/e202/"
}


@Article{info:doi/10.2196/jmir.9779,
author="Komarzynski, Sandra
and Huang, Qi
and Innominato, F. Pasquale
and Maurice, Monique
and Arbaud, Alexandre
and Beau, Jacques
and Bouchahda, Mohamed
and Ulusakarya, Ayhan
and Beaumatin, Nicolas
and Breda, Gabri{\`e}le
and Finkenst{\"a}dt, B{\"a}rbel
and L{\'e}vi, Francis",
title="Relevance of a Mobile Internet Platform for Capturing Inter- and Intrasubject Variabilities in Circadian Coordination During Daily Routine: Pilot Study",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="11",
volume="20",
number="6",
pages="e204",
keywords="circadian clock",
keywords="eHealth",
keywords="temperature rhythm",
keywords="rest-activity rhythm",
keywords="time series analyses",
keywords="domomedicine",
keywords="biomarkers",
abstract="Background: Experimental and epidemiologic studies have shown that circadian clocks' disruption can play an important role in the development of cancer and metabolic diseases. The cellular clocks outside the brain are effectively coordinated by the body temperature rhythm. We hypothesized that concurrent measurements of body temperature and rest-activity rhythms would assess circadian clocks coordination in individual patients, thus enabling the integration of biological rhythms into precision medicine. Objective: The objective was to evaluate the circadian clocks' coordination in healthy subjects and patients through simultaneous measurements of rest-activity and body temperature rhythms. Methods: Noninvasive real-time measurements of rest-activity and chest temperature rhythms were recorded during the subject's daily life, using a dedicated new mobile electronic health platform (PiCADo). It involved a chest sensor that jointly measured accelerations, 3D orientation, and skin surface temperature every 1-5 min and relayed them out to a mobile gateway via Bluetooth Low Energy. The gateway tele-transmitted all stored data to a server via General Packet Radio Service every 24 hours. The technical capabilities of PiCADo were validated in 55 healthy subjects and 12 cancer patients, whose rhythms were e-monitored during their daily routine for 3-30 days. Spectral analyses enabled to compute rhythm parameters values, with their 90\% confidence limits, and their dynamics in each subject. Results: All the individuals displayed a dominant circadian rhythm in activity with maxima occurring from 12:09 to 20:25. This was not the case for the dominant temperature period, which clustered around 24 hours for 51 out of 67 subjects (76\%), and around 12 hours for 13 others (19\%). Statistically significant sex- and age-related differences in circadian coordination were identified in the noncancerous subjects, based upon the range of variations in temperature rhythm amplitudes, maxima (acrophases), and phase relations with rest-activity. The circadian acrophase of chest temperature was located at night for the majority of people, but it occurred at daytime for 26\% (14/55) of the noncancerous people and 33\% (4/12) of the cancer patients, thus supporting important intersubject differences in circadian coordination. Sex, age, and cancer significantly impacted the circadian coordination of both rhythms, based on their phase relationships. Conclusions: Complementing rest-activity with chest temperature circadian e-monitoring revealed striking intersubject differences regarding human circadian clocks' coordination and timing during daily routine. To further delineate the clinical importance of such finding, the PiCADo platform is currently applied for both the assessment of health effects resulting from atypical work schedules and the identification of the key determinants of circadian disruption in cancer patients. ",
doi="10.2196/jmir.9779",
url="http://www.jmir.org/2018/6/e204/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29704408"
}


@Article{info:doi/10.2196/jmir.9812,
author="Marzorati, Chiara
and Renzi, Chiara
and Russell-Edu, William Samuel
and Pravettoni, Gabriella",
title="Telemedicine Use Among Caregivers of Cancer Patients: Systematic Review",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="18",
volume="20",
number="6",
pages="e223",
keywords="telemedicine",
keywords="family",
keywords="caregivers",
keywords="neoplasms",
keywords="systematic review",
abstract="Background: The number of published studies and systematic reviews examining different telehealth interventions targeting patients and their effects on patients' well-being and quality of life have grown in recent decades. However, the use of telemedicine tools aimed at the family members and caregivers of adult cancer patients is less defined. Objective: We aimed to conduct a systematic review to provide a more complete picture regarding telemedicine tools for informal caregivers (usually family members or close friends) implemented in all phases of cancer care. More specifically, the review aimed to better describe the study samples' characteristics, to analyze measured outcomes and the specific questionnaires used to assess them, and to describe in depth the implemented interventions and their formats. Finally, we examined the role of telehealth, and usability and feasibility trends in supporting patients' caregivers. Methods: We systematically searched the literature in the following databases: Web of Science, Cochrane Library, PubMed, Scopus, CINAHL, MEDLINE, EMBASE, Google Scholar, and PsycINFO. Inclusion criteria were being written in English, published in peer-reviewed journals, describing a telehealth-implemented intervention, and focusing on caregivers of adult cancer patients at any stage of the disease. We selected studies published up to November 2017. We critically appraised included articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and graded the quality of evidence by outcome using the Centre for Evidence-Based Medicine framework. Results: We included 24 studies in the final selection. In 21 of the 24 studies, the patient-caregiver dyad was analyzed, and the study population dealt with different types of cancer at different stages. Included studies considered the caregiver's condition from both an individual and a relational point of view. Along with psychosocial variables, some studies monitored engagement and user satisfaction regarding Web-based platforms or telehealth interventions. All studies reported significant improvements in some of the investigated areas, but they often showed small effect sizes. Two types of telehealth intervention formats were used: Web-based platforms and telephone calls. Some of the included studies referred to the same project, but on study samples with different cancer diagnoses or with new versions of previously developed interventions. Conclusions: Reported outcomes seem to suggest that we are in an exploratory phase. More detailed and targeted research hypotheses are still needed. Clarifying caregivers' needs related to telehealth tools and better defining outcome measures may yield more significant results. ",
doi="10.2196/jmir.9812",
url="http://www.jmir.org/2018/6/e223/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29914858"
}


@Article{info:doi/10.2196/jmir.9940,
author="Walters, Marolana Laticha Elizabeth
and Scott, Ernest Richard
and Mars, Maurice",
title="A Teledermatology Scale-Up Framework and Roadmap for Sustainable Scaling: Evidence-Based Development",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="20",
volume="20",
number="6",
pages="e224",
keywords="teledermatology",
keywords="scale-up",
keywords="Teledermatology Scale-up Framework",
keywords="TDSF",
keywords="Teledermatology Scale-up Framework Implementation Roadmap",
keywords="TDSF-IR",
keywords="design science research",
keywords="KwaZulu-Natal",
keywords="South Africa",
abstract="Background: The objectives of South Africa's electronic health (eHealth) strategy recognize the value proposition that telemedicine practices hold for rural and urban referrals, but a lack of accepted and formalized scale-up has impeded realization of benefits. While both synchronous and asynchronous teledermatology exist, these remain localized and not scaled-up. Skin pathology is often the first sign of an HIV/AIDS infection, which remains a major cause of morbidity and mortality in South Africa. It is essential to replace the current inefficient dermatology referral process with a swift, organized, and efficacious one. Objective: The objective of this study is to present an evidenced-based teledermatology scale-up framework (TDSF) and implementation roadmap (TDSF-IR). Methods: A qualitative method with a design science research process model was used which consisted of 5 phases: (1) Awareness, which confirmed the need for an evidence-based TDSF and supporting TDSF-IR; (2) Suggestion, where a proposal was delivered on how to develop a TDSF and TDSF-IR; (3) Development, where we identified recommended design requirements and used these to identify and critique existing teledermatology or related scale-up frameworks; (4) Evaluation and validation, where we assessed outputs of the development phase against the design requirements and validated by confirming the veracity of the TDSF and TDSF-IR (validation involved 4 key senior teledermatology stakeholders using a questionnaire with a 5-point Likert scale); and (5) Conclusion, where validation results were used to finalize and communicate the TDSF and TDSF-IR to users. Results: The study identified 5 TDSF components: eHealth building blocks, eHealth strategic objectives and budget, scale-up continuum periods, scale-up drivers, and scale-up phases. In addition, 36 subcomponents were identified. Each was further characterized and described to enable design of the final evidence-based TDSF. An implementation roadmap (TDSF-IR) was also prepared as a guide for an implementer with step-by-step instructions for application of the TDSF. For the validation study of the TDSF and supporting TDSF-IR, 4 purposively selected key senior teledermatology management stakeholders were asked if they found it useful as a guide to assist the South African public health system with teledermatology scale-up. The mean (SD) of Likert-scale rating was 4.0 (0.53) where 4=Agree and 33 of 36 responses were either agree or strongly agree. Conclusions: This study developed a TDSF and supporting roadmap (TDSF-IR) that are evidence-based. The proposed approach and described tools could be adapted to assist with ensuring scale-up and sustainability for other eHealth practices in other locations. ",
doi="10.2196/jmir.9940",
url="http://www.jmir.org/2018/6/e224/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29925492"
}


@Article{info:doi/10.2196/jmir.9943,
author="Avila, Andrea
and Claes, Jomme
and Goetschalckx, Kaatje
and Buys, Roselien
and Azzawi, May
and Vanhees, Luc
and Cornelissen, V{\'e}ronique",
title="Home-Based Rehabilitation With Telemonitoring Guidance for Patients With Coronary Artery Disease (Short-Term Results of the TRiCH Study): Randomized Controlled Trial",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="22",
volume="20",
number="6",
pages="e225",
keywords="cardiac rehabilitation",
keywords="telemonitoring",
keywords="exercise",
keywords="coronary artery disease",
abstract="Background: Cardiac rehabilitation (CR) is an essential part of contemporary coronary heart disease management. However, patients exiting a center-based CR program have difficulty retaining its benefits. Objective: We aimed to evaluate the added benefit of a home-based CR program with telemonitoring guidance on physical fitness in patients with coronary artery disease (CAD) completing a phase II ambulatory CR program and to compare the effectiveness of this program in a prolonged center-based CR intervention by means of a randomized controlled trial. Methods: Between February 2014 and August 2016, 90 CAD patients (unblinded, mean age 61.2 years, SD 7.6; 80/90, 89.0\% males; mean height 1.73 m, SD 0.7; mean weight 82.9 kg, SD 13; mean body mass index 27.5 kg/m2, SD 3.4) who successfully completed a 3-month ambulatory CR program were randomly allocated to one of three groups: home-based (30), center-based (30), or control group (30) on a 1:1:1 basis. Home-based patients received a home-based exercise intervention with telemonitoring guidance consisting of weekly emails or phone calls; center-based patients continued the standard in-hospital CR, and control group patients received the usual care including the advice to remain physically active. All the patients underwent cardiopulmonary exercise testing for assessment of their peak oxygen uptake (VO2 P) at baseline and after a 12-week intervention period. Secondary outcomes included physical activity behavior, anthropometric characteristics, traditional cardiovascular risk factors, and quality of life. Results: Following 12 weeks of intervention, the increase in VO2 P was larger in the center-based (P=.03) and home-based (P=.04) groups than in the control group. In addition, oxygen uptake at the first (P-interaction=.03) and second (P-interaction=.03) ventilatory thresholds increased significantly more in the home-based group than in the center-based group. No significant changes were observed in the secondary outcomes. Conclusions: Adding a home-based exercise program with telemonitoring guidance following completion of a phase II ambulatory CR program results in further improvement of physical fitness and is equally as effective as prolonging a center-based CR in patients with CAD. Trial Registration: ClinicalTrials.gov NCT02047942; https://clinicaltrials.gov/ct2/show/NCT02047942 (Archived by WebCite at http://www.webcitation.org/70CBkSURj) ",
doi="10.2196/jmir.9943",
url="http://www.jmir.org/2018/6/e225/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29934286"
}


@Article{info:doi/10.2196/jmir.9866,
author="Sturesson, Linda
and Groth, Kristina",
title="Effects of the Digital Transformation: Qualitative Study on the Disturbances and Limitations of Using Video Visits in Outpatient Care",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="27",
volume="20",
number="6",
pages="e221",
keywords="Video visit, outpatient care, disturbance, perceived limitation, telemedicine, telehealth, ethnography",
abstract="Background: Video mediated meetings with patients were introduced in outpatient care at a hospital in Sweden. New behaviours and tasks emerged due to changes of roles, work processes and responsibilities. The study investigates effects of digital transformation, in this case how video visits in outpatient care change work processes and introduces new tasks, in order to further improve the concept of video visits. Objective: Through real-time, social interactional features of preparing for and conducting video visits, the study examines clinicians' perceived limitations and disturbances, and how the conditions between patients and clinicians may change when using video visits instead of face-to-face meetings in outpatient care. Methods: Qualitative methods have been used including 14 observations of video visits at two different clinics and 14 followup interviews with clinicians. Transcriptions of interviews and field notes were thematically analysed, discussed and synthesised into themes. Results: Disturbances and limitations related to the technology were related to time; a flexibility to schedule the meeting unbound of place, frustrations when the other part was late for the scheduled meeting, and that more experienced users of video visits usually waited longer before logging in. They were also related to sound; problems getting the sound to work satisfactory during the video visits, and problems with the image. Disturbances and limitations related to the surroundings were related to both the patient's and the clinician's environment; the principle of video technology in itself may affect the experience and the content of the consultation, and the surrounding chosen changes the conditions for and reduces the participants' field of view. Conclusions: We could see 1) a transformation of roles and responsibilities when turning from face-to-face meetings to video visits, 2) that video visits add new circumstances, with a risk of introducing disturbances and limitations, that in turn affects the content of the meeting, 3) that avoiding negative disturbances during a video visit, requires a sensibility from the clinician's side as well as a trust in the patient's judgement, 4) that both expected and unexpected disturbances and limitations during a video visit affect the clinician's behaviour, feelings, the content of the meeting and how the clinician's relate to the different components of the concept, and 5) that there is a change of roles introduced when conducting video visits, eg, the clinician taking the first line support if both (s)he and the patient encounter problems with the technology. ",
doi="10.2196/jmir.9866",
url="http://www.jmir.org/2018/6/e221/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29950290"
}


@Article{info:doi/10.2196/jmir.9458,
author="Dietrich, Damien
and Dekova, Ralitza
and Davy, Stephan
and Fahrni, Guillaume
and Geissb{\"u}hler, Antoine",
title="Applications of Space Technologies to Global Health: Scoping Review",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="27",
volume="20",
number="6",
pages="e230",
keywords="satellite imagery",
keywords="satellite communications",
keywords="public health",
keywords="remote sensing technology",
keywords="global positioning system",
keywords="geographic information systems",
keywords="telemedicine",
keywords="spaceflight",
keywords="space medicine",
keywords="global health",
abstract="Background: Space technology has an impact on many domains of activity on earth, including in the field of global health. With the recent adoption of the United Nations' Sustainable Development Goals that highlight the need for strengthening partnerships in different domains, it is useful to better characterize the relationship between space technology and global health. Objective: The aim of this study was to identify the applications of space technologies to global health, the key stakeholders in the field, as well as gaps and challenges. Methods: We used a scoping review methodology, including a literature review and the involvement of stakeholders, via a brief self-administered, open-response questionnaire. A distinct search on several search engines was conducted for each of the four key technological domains that were previously identified by the UN Office for Outer Space Affairs' Expert Group on Space and Global Health (Domain A: remote sensing; Domain B: global navigation satellite systems; Domain C: satellite communication; and Domain D: human space flight). Themes in which space technologies are of benefit to global health were extracted. Key stakeholders, as well as gaps, challenges, and perspectives were identified. Results: A total of 222 sources were included for Domain A, 82 sources for Domain B, 144 sources for Domain C, and 31 sources for Domain D. A total of 3 questionnaires out of 16 sent were answered. Global navigation satellite systems and geographic information systems are used for the study and forecasting of communicable and noncommunicable diseases; satellite communication and global navigation satellite systems for disaster response; satellite communication for telemedicine and tele-education; and global navigation satellite systems for autonomy improvement, access to health care, as well as for safe and efficient transportation. Various health research and technologies developed for inhabited space flights have been adapted for terrestrial use. Conclusions: Although numerous examples of space technology applications to global health exist, improved awareness, training, and collaboration of the research community is needed. ",
doi="10.2196/jmir.9458",
url="http://www.jmir.org/2018/6/e230/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29950289"
}


@Article{info:doi/10.2196/10762,
author="Odenheimer, Sandra
and Goyal, Deepika
and Jones, Goel Veena
and Rosenblum, Ruth
and Ho, Lam
and Chan, S. Albert",
title="Patient Acceptance of Remote Scribing Powered by Google Glass in Outpatient Dermatology: Cross-Sectional Study",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="21",
volume="20",
number="6",
pages="e10762",
keywords="acceptance, clinician burnout, communication, Google Glass, health care provider, patient, remote scribing, trust",
abstract="Background: The ubiquitous use of electronic health records (EHRs) during medical office visits using a computer monitor and keyboard can be distracting and can disrupt patient-health care provider (HCP) nonverbal eye contact cues, which are integral to effective communication. Provider use of a remote medical scribe with face-mounted technology (FMT), such as Google Glass, may preserve patient-HCP communication dynamics in health care settings by allowing providers to maintain direct eye contact with their patients while still having access to the patient's relevant EHR information. The medical scribe is able to chart patient encounters in real-time working in an offsite location, document the visit directly into EHR, and free HCP to focus only on the patient. Objective: The purpose of this study was to examine patient perceptions of their interactions with an HCP who used FMT with a remote medical scribe during office visits. This includes an examination of any association between patient privacy and trust in their HCP when FMT is used in the medical office setting. Methods: For this descriptive, cross-sectional study, a convenience sample of patients was recruited from an outpatient dermatology clinic in Northern California. Participants provided demographic data and completed a 12-item questionnaire to assess their familiarity, comfort, privacy, and perceptions following routine office visits with an HCP where FMT was used to document the clinical encounter. Data were analyzed using appropriate descriptive and inferential statistics. Results: Over half of the 170 study participants were female (102/170, 59.4\%), 60.0\% were Caucasian (102/170), 24.1\% were Asian (41/170), and 88.8\% were college-educated (151/170). Age ranged between 18 and 90 years (mean 50.5, SD 17.4). The majority of participants (118/170, 69.4\%) were familiar with FMT, not concerned with privacy issues (132/170, 77.6\%), and stated that the use of FMT did not affect their trust in their HCP (139/170, 81.8\%). Moreover, participants comfortable with the use of FMT were less likely to be concerned about privacy (P<.001) and participants who trusted their HCP were less likely to be concerned about their HCP using Google Glass (P<.009). Almost one-third of them self-identified as early technology adopters (49/170, 28.8\%) and 87\% (148/170) preferred their HCP using FMT if it delivered better care. Conclusions: Our study findings support the patient acceptance of Google Glass use for outpatient dermatology visits. Future research should explore the use of FMT in other areas of health care and strive to include a socioeconomically diverse patient population in study samples. ",
doi="10.2196/10762",
url="http://www.jmir.org/2018/6/e10762/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29929947"
}


@Article{info:doi/10.2196/jmir.9702,
author="Guetterman, C. Timothy
and Chang, Tammy
and DeJonckheere, Melissa
and Basu, Tanmay
and Scruggs, Elizabeth
and Vydiswaran, Vinod V. G.",
title="Augmenting Qualitative Text Analysis with Natural Language Processing: Methodological Study",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="29",
volume="20",
number="6",
pages="e231",
keywords="qualitative research",
keywords="natural language processing",
keywords="text data",
keywords="methodology",
keywords="coding",
abstract="Background: Qualitative research methods are increasingly being used across disciplines because of their ability to help investigators understand the perspectives of participants in their own words. However, qualitative analysis is a laborious and resource-intensive process. To achieve depth, researchers are limited to smaller sample sizes when analyzing text data. One potential method to address this concern is natural language processing (NLP). Qualitative text analysis involves researchers reading data, assigning code labels, and iteratively developing findings; NLP has the potential to automate part of this process. Unfortunately, little methodological research has been done to compare automatic coding using NLP techniques and qualitative coding, which is critical to establish the viability of NLP as a useful, rigorous analysis procedure. Objective: The purpose of this study was to compare the utility of a traditional qualitative text analysis, an NLP analysis, and an augmented approach that combines qualitative and NLP methods. Methods: We conducted a 2-arm cross-over experiment to compare qualitative and NLP approaches to analyze data generated through 2 text (short message service) message survey questions, one about prescription drugs and the other about police interactions, sent to youth aged 14-24 years. We randomly assigned a question to each of the 2 experienced qualitative analysis teams for independent coding and analysis before receiving NLP results. A third team separately conducted NLP analysis of the same 2 questions. We examined the results of our analyses to compare (1) the similarity of findings derived, (2) the quality of inferences generated, and (3) the time spent in analysis. Results: The qualitative-only analysis for the drug question (n=58) yielded 4 major findings, whereas the NLP analysis yielded 3 findings that missed contextual elements. The qualitative and NLP-augmented analysis was the most comprehensive. For the police question (n=68), the qualitative-only analysis yielded 4 primary findings and the NLP-only analysis yielded 4 slightly different findings. Again, the augmented qualitative and NLP analysis was the most comprehensive and produced the highest quality inferences, increasing our depth of understanding (ie, details and frequencies). In terms of time, the NLP-only approach was quicker than the qualitative-only approach for the drug (120 vs 270 minutes) and police (40 vs 270 minutes) questions. An approach beginning with qualitative analysis followed by qualitative- or NLP-augmented analysis took longer time than that beginning with NLP for both drug (450 vs 240 minutes) and police (390 vs 220 minutes) questions. Conclusions: NLP provides both a foundation to code qualitatively more quickly and a method to validate qualitative findings. NLP methods were able to identify major themes found with traditional qualitative analysis but were not useful in identifying nuances. Traditional qualitative text analysis added important details and context. ",
doi="10.2196/jmir.9702",
url="http://www.jmir.org/2018/6/e231/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29959110"
}


@Article{info:doi/10.2196/jmir.9070,
author="Baptista, Sofia
and Teles Sampaio, Elvira
and Heleno, Bruno
and Azevedo, Filipe Lu{\'i}s
and Martins, Carlos",
title="Web-Based Versus Usual Care and Other Formats of Decision Aids to Support Prostate Cancer Screening Decisions: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="26",
volume="20",
number="6",
pages="e228",
keywords="decision making",
keywords="decision aid",
keywords="internet",
keywords="patient participation",
keywords="prostate",
keywords="screening",
abstract="Background: Prostate cancer is a leading cause of cancer among men. Because screening for prostate cancer is a controversial issue, many experts in the field have defended the use of shared decision making using validated decision aids, which can be presented in different formats (eg, written, multimedia, Web). Recent studies have concluded that decision aids improve knowledge and reduce decisional conflict. Objective: This meta-analysis aimed to investigate the impact of using Web-based decision aids to support men's prostate cancer screening decisions in comparison with usual care and other formats of decision aids. Methods: We searched PubMed, CINAHL, PsycINFO, and Cochrane CENTRAL databases up to November 2016. This search identified randomized controlled trials, which assessed Web-based decision aids for men making a prostate cancer screening decision and reported quality of decision-making outcomes. Two reviewers independently screened citations for inclusion criteria, extracted data, and assessed risk of bias. Using a random-effects model, meta-analyses were conducted pooling results using mean differences (MD), standardized mean differences (SMD), and relative risks (RR). Results: Of 2406 unique citations, 7 randomized controlled trials met the inclusion criteria. For risk of bias, selective outcome reporting and participant/personnel blinding were mostly rated as unclear due to inadequate reporting. Based on seven items, two studies had high risk of bias for one item. Compared to usual care, Web-based decision aids increased knowledge (SMD 0.46; 95\% CI 0.18-0.75), reduced decisional conflict (MD --7.07\%; 95\% CI --9.44 to --4.71), and reduced the practitioner control role in the decision-making process (RR 0.50; 95\% CI 0.31-0.81). Web-based decision aids compared to printed decision aids yielded no differences in knowledge, decisional conflict, and participation in decision or screening behaviors. Compared to video decision aids, Web-based decision aids showed lower average knowledge scores (SMD --0.50; 95\% CI --0.88 to --0.12) and a slight decrease in prostate-specific antigen screening (RR 1.12; 95\% CI 1.01-1.25). Conclusions: According to this analysis, Web-based decision aids performed similarly to alternative formats (ie, printed, video) for the assessed decision-quality outcomes. The low cost, readiness, availability, and anonymity of the Web can be an advantage for increasing access to decision aids that support prostate cancer screening decisions among men. ",
doi="10.2196/jmir.9070",
url="http://www.jmir.org/2018/6/e228/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29945857"
}


@Article{info:doi/10.2196/10197,
author="Bruns, J. Eric
and Hook, N. Alyssa
and Parker, M. Elizabeth
and Esposito, Isabella
and Sather, April
and Parigoris, M. Ryan
and Lyon, R. Aaron
and Hyde, L. Kelly",
title="Impact of a Web-Based Electronic Health Record on Behavioral Health Service Delivery for Children and Adolescents: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="14",
volume="20",
number="6",
pages="e10197",
keywords="mental health",
keywords="medical informatics",
keywords="electronic health records",
keywords="child",
keywords="adolescent",
keywords="integrated care",
keywords="care coordination",
abstract="Background: Electronic health records (EHRs) have been widely proposed as a mechanism for improving health care quality. However, rigorous research on the impact of EHR systems on behavioral health service delivery is scant, especially for children and adolescents. Objective: The current study evaluated the usability of an EHR developed to support the implementation of the Wraparound care coordination model for children and youth with complex behavioral health needs, and impact of the EHR on service processes, fidelity, and proximal outcomes. Methods: Thirty-four Wraparound facilitators working in two programs in two states were randomized to either use the new EHR (19/34, 56\%) or to continue to implement Wraparound services as usual (SAU) using paper-based documentation (15/34, 44\%). Key functions of the EHR included standard fields such as youth and family information, diagnoses, assessment data, and progress notes. In addition, there was the maintenance of a coordinated plan of care, progress measurement on strategies and services, communication among team members, and reporting on services, expenditures, and outcomes. All children and youth referred to services for eight months (N=211) were eligible for the study. After excluding those who were ineligible (69/211, 33\%) and who declined to participate (59/211, 28\%), a total of 83/211 (39\%) children and youth were enrolled in the study with 49/211 (23\%) in the EHR condition and 34/211 (16\%) in the SAU condition. Facilitators serving these youth and families and their supervisors completed measures of EHR usability and appropriateness, supervision processes and activities, work satisfaction, and use of and attitudes toward standardized assessments. Data from facilitators were collected by web survey and, where necessary, by phone interviews. Parents and caregivers completed measures via phone interviews. Related to fidelity and quality of behavioral health care, including Wraparound team climate, working alliance with providers, fidelity to the Wraparound model, and satisfaction with services. Results: EHR-assigned facilitators from both sites demonstrated the robust use of the system. Facilitators in the EHR group reported spending significantly more time reviewing client progress (P=.03) in supervision, and less time overall sending reminders to youth/families (P=.04). A trend toward less time on administrative tasks (P=.098) in supervision was also found. Facilitators in both groups reported significantly increased use of measurement-based care strategies overall, which may reflect cross-group contamination (given that randomization of staff to the EHR occurred within agencies and supervisors supervised both types of staff). Although not significant at P<.05, there was a trend (P=.10) toward caregivers in the EHR group reporting poorer shared agreement on tasks on the measure of working alliance with providers. No other significant between-group differences were found. Conclusions: Results support the proposal that use of EHR systems can promote the use of client progress data and promote efficiency; however, there was little evidence of any impact (positive or negative) on overall service quality, fidelity, or client satisfaction. The field of children's behavioral health services would benefit from additional research on EHR systems using designs that include larger sample sizes and longer follow-up periods. Trial Registration: ClinicalTrials.gov NCT02421874; https://clinicaltrials.gov/ct2/show/NCT02421874 (Archived by WebCite at http://www.webcitation.org/6yyGPJ3NA) ",
doi="10.2196/10197",
url="http://www.jmir.org/2018/6/e10197/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29903701"
}


@Article{info:doi/10.2196/jmir.9203,
author="Bose-Brill, Seuli
and Feeney, Michelle
and Prater, Laura
and Miles, Laura
and Corbett, Angela
and Koesters, Stephen",
title="Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="26",
volume="20",
number="6",
pages="e208",
keywords="advance care planning",
keywords="electronic health records",
keywords="patient portal",
abstract="Background: Advance care planning allows patients to articulate their future care preferences should they no longer be able to make decisions on their own. Early advance care planning in outpatient settings provides benefits such as less aggressive care and fewer hospitalizations, yet it is underutilized due to barriers such as provider time constraints and communication complexity. Novel methods, such as patient portals, provide a unique opportunity to conduct advance care planning previsit planning for outpatient care. This follow-up to our pilot study aimed to conduct pragmatic testing of a novel electronic health record-tethered framework and its effects on advance care planning delivery in a real-world primary care setting. Objective: Our intervention tested a previsit advance care planning workflow centered around a framework sent via secure electronic health record-linked patient portal in a real-world clinical setting. The primary objective of this study was to determine its impact on frequency and quality of advance care planning documentation. Methods: We conducted a pragmatic trial including 2 sister clinical sites, one site implementing the intervention and the other continuing standard care. A total of 419 patients aged between 50 and 93 years with active portal accounts received intervention (n=200) or standard care (n=219). Chart review analyzed the presence of advance care planning and its quality and was graded with previously established scoring criteria based on advance care planning best practice guidelines from multiple nations. Results: A total of 19.5\% (39/200) of patients who received previsit planning responded to the framework. We found that the intervention site had statistically significant improvement in new advance care planning documentation rates (P<.01) and quality (P<.01) among all eligible patients. Advance care planning documentation rates increased by 105\% (19/39 to 39/39) and quality improved among all patients who engaged in the previsit planning framework (n=39). Among eligible patients aged between 50 and 60 years at the intervention site, advance care planning documentation rates increased by 37\% (27/96 to 37/96). Advance care planning documentation rates increased 34\% among high users (27/67 to 36/67). Conclusions: Advance care planning previsit planning using a secure electronic health record-supported patient portal framework yielded improvement in the presence of advance care planning documentation, with highest improvement in active patient portal users and patients aged between 50 and 60 years. Targeted previsit patient portal advance care planning delivery in these populations can potentially improve the quality of care in these populations. ",
doi="10.2196/jmir.9203",
url="http://www.jmir.org/2018/6/e208/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29945860"
}


@Article{info:doi/10.2196/jmir.9670,
author="Ma, D. Ben
and Ng, Leung Sai
and Schwanen, Tim
and Zacharias, John
and Zhou, Mudi
and Kawachi, Ichiro
and Sun, Guibo",
title="Pok{\'e}mon GO and Physical Activity in Asia: Multilevel Study",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="15",
volume="20",
number="6",
pages="e217",
keywords="physical activity",
keywords="Pok{\'e}mon Go",
keywords="public health intervention",
keywords="exergame",
keywords="weather",
abstract="Background: Physical activity has long been considered as an important component of a healthy lifestyle. Although many efforts have been made to promote physical activity, there is no effective global intervention for physical activity promotion. Some researchers have suggested that Pok{\'e}mon GO, a location-based augmented reality game, was associated with a short-term increase in players' physical activity on a global scale, but the details are far from clear. Objective: The objective of our study was to study the relationship between Pok{\'e}mon GO use and players' physical activity and how the relationship varies across players with different physical activity levels. Methods: We conducted a field study in Hong Kong to investigate if Pok{\'e}mon GO use was associated with physical activity. Pok{\'e}mon GO players were asked to report their demographics through a survey; data on their Pok{\'e}mon GO behaviors and daily walking and running distances were collected from their mobile phones. Participants (n=210) were Hong Kong residents, aged 13 to 65 years, who played Pok{\'e}mon GO using iPhone 5 or 6 series in 5 selected types of built environment. We measured the participants' average daily walking and running distances over a period of 35 days, from 14 days before to 21 days after game installation. Multilevel modeling was used to identify and examine the predictors (including Pok{\'e}mon GO behaviors, weather, demographics, and built environment) of the relationship between Pok{\'e}mon GO use and daily walking and running distances. Results: The average daily walking and running distances increased by 18.1\% (0.96 km, approximately 1200 steps) in the 21 days after the participants installed Pok{\'e}mon GO compared with the average distances over the 14 days before installation (P<.001). However, this association attenuated over time and was estimated to disappear 24 days after game installation. Multilevel models indicated that Pok{\'e}mon GO had a stronger and more lasting association among the less physically active players compared with the physically active ones (P<.001). Playing Pok{\'e}mon GO in green space had a significant positive relationship with daily walking and running distances (P=.03). Moreover, our results showed that whether Pok{\'e}mon GO was played, the number of days played, weather (total rainfall, bright sunshine, mean air temperature, and mean wind speed), and demographics (age, gender, income, education, and body mass index) were associated with daily walking and running distances. Conclusions: Pok{\'e}mon GO was associated with a short-term increase in the players' daily walking and running distances; this association was especially strong among less physically active participants. Pok{\'e}mon GO can build new links between humans and green space and encourage people to engage in physical activity. Our results show that location-based augmented reality games, such as Pok{\'e}mon GO, have the potential to be a global public health intervention tool. ",
doi="10.2196/jmir.9670",
url="http://www.jmir.org/2018/6/e217/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29907559"
}


@Article{info:doi/10.2196/jmir.9709,
author="Hargreaves, Sarah
and Bath, A. Peter
and Duffin, Suzanne
and Ellis, Julie",
title="Sharing and Empathy in Digital Spaces: Qualitative Study of Online Health Forums for Breast Cancer and Motor Neuron Disease (Amyotrophic Lateral Sclerosis)",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="14",
volume="20",
number="6",
pages="e222",
keywords="online health forum",
keywords="sharing",
keywords="breast cancer",
keywords="motor neuron disease",
keywords="amyotrophic lateral sclerosis",
keywords="empathy",
abstract="Background: The availability of an increasing number of online health forums has altered the experience of living with a health condition, as more people are now able to connect and support one another. Empathy is an important component of peer-to-peer support, although little is known about how empathy develops and operates within online health forums. Objective: The aim of this paper is to explore how empathy develops and operates within two online health forums for differing health conditions: breast cancer and motor neuron disease (MND), also known as amyotrophic lateral sclerosis. Methods: This qualitative study analyzed data from two sources: interviews with forum users and downloaded forum posts. Data were collected from two online health forums provided by UK charities: Breast Cancer Care and the Motor Neurone Disease Association. We analyzed 84 threads from the breast cancer forum and 52 from the MND forum. Threads were purposively sampled to reflect varied experiences (eg, illness stages, topics of conversation, and user characteristics). Semistructured interviews were conducted with 14 Breast Cancer Care forum users and five users of the MND forum. All datasets were analyzed thematically using Braun and Clarke's six-phase approach and combined to triangulate the analysis. Results: We found that empathy develops and operates through shared experiences and connections. The development of empathy begins outside the forum with experiences of illness onset and diagnosis, creating emotional and informational needs. Users came to the forum and found their experiences and needs were shared and understood by others, setting the empathetic tone and supportive ethos of the forum. The forum was viewed as both a useful and meaningful space in which they could share experiences, information, and emotions, and receive empathetic support within a supportive and warm atmosphere. Empathy operated through connections formed within this humane space based on similarity, relationships, and shared feelings. Users felt a need to connect to users who they felt were like themselves (eg, people sharing the same specific diagnosis). They formed relationships with other users. They connected based on the emotional understanding of ill health. Within these connections, empathic communication flourished. Conclusions: Empathy develops and operates within shared experiences and connections, enabled by structural possibilities provided by the forums giving users the opportunity and means to interact within public, restricted, and more private spaces, as well as within groups and in one-to-one exchanges. The atmosphere and feeling of both sites and perceived audiences were important facilitators of empathy, with users sharing a perception of virtual communities of caring and supportive people. Our findings are of value to organizations hosting health forums and to health professionals signposting patients to additional sources of support. ",
doi="10.2196/jmir.9709",
url="http://www.jmir.org/2018/6/e222/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29903695"
}


@Article{info:doi/10.2196/jmir.9840,
author="Alada?, Emre Ahmet
and Muderrisoglu, Serra
and Akbas, Berfu Naz
and Zahmacioglu, Oguzhan
and Bingol, O. Haluk",
title="Detecting Suicidal Ideation on Forums: Proof-of-Concept Study",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="21",
volume="20",
number="6",
pages="e215",
keywords="suicide",
keywords="suicidal ideation",
keywords="suicidality",
keywords="detection",
keywords="prevention",
keywords="classification model",
keywords="text mining",
keywords="machine learning",
keywords="artificial intelligence",
keywords="suicidal surveillance",
abstract="Background: In 2016, 44,965 people in the United States died by suicide. It is common to see people with suicidal ideation seek help or leave suicide notes on social media before attempting suicide. Many prefer to express their feelings with longer passages on forums such as Reddit and blogs. Because these expressive posts follow regular language patterns, potential suicide attempts can be prevented by detecting suicidal posts as they are written. Objective: This study aims to build a classifier that differentiates suicidal and nonsuicidal forum posts via text mining methods applied on post titles and bodies. Methods: A total of 508,398 Reddit posts longer than 100 characters and posted between 2008 and 2016 on SuicideWatch, Depression, Anxiety, and ShowerThoughts subreddits were downloaded from the publicly available Reddit dataset. Of these, 10,785 posts were randomly selected and 785 were manually annotated as suicidal or nonsuicidal. Features were extracted using term frequency-inverse document frequency, linguistic inquiry and word count, and sentiment analysis on post titles and bodies. Logistic regression, random forest, and support vector machine (SVM) classification algorithms were applied on resulting corpus and prediction performance is evaluated. Results: The logistic regression and SVM classifiers correctly identified suicidality of posts with 80\% to 92\% accuracy and F1 score, respectively, depending on different data compositions closely followed by random forest, compared to baseline ZeroR algorithm achieving 50\% accuracy and 66\% F1 score. Conclusions: This study demonstrated that it is possible to detect people with suicidal ideation on online forums with high accuracy. The logistic regression classifier in this study can potentially be embedded on blogs and forums to make the decision to offer real-time online counseling in case a suicidal post is being written. ",
doi="10.2196/jmir.9840",
url="http://www.jmir.org/2018/6/e215/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29929945"
}


@Article{info:doi/10.2196/10311,
author="Guo, Yanting
and Zheng, Gang
and Fu, Tianyun
and Hao, Shiying
and Ye, Chengyin
and Zheng, Le
and Liu, Modi
and Xia, Minjie
and Jin, Bo
and Zhu, Chunqing
and Wang, Oliver
and Wu, Qian
and Culver, S. Devore
and Alfreds, T. Shaun
and Stearns, Frank
and Kanov, Laura
and Bhatia, Ajay
and Sylvester, G. Karl
and Widen, Eric
and McElhinney, B. Doff
and Ling, Bruce Xuefeng",
title="Assessing Statewide All-Cause Future One-Year Mortality: Prospective Study With Implications for Quality of Life, Resource Utilization, and Medical Futility",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="04",
volume="20",
number="6",
pages="e10311",
keywords="One-year mortality risk prediction",
keywords="electronic medical records",
keywords="quality of life",
keywords="healthcare resource utilization",
keywords="social determinants",
abstract="Background: For many elderly patients, a disproportionate amount of health care resources and expenditures is spent during the last year of life, despite the discomfort and reduced quality of life associated with many aggressive medical approaches. However, few prognostic tools have focused on predicting all-cause 1-year mortality among elderly patients at a statewide level, an issue that has implications for improving quality of life while distributing scarce resources fairly. Objective: Using data from a statewide elderly population (aged ?65 years), we sought to prospectively validate an algorithm to identify patients at risk for dying in the next year for the purpose of minimizing decision uncertainty, improving quality of life, and reducing futile treatment. Methods: Analysis was performed using electronic medical records from the Health Information Exchange in the state of Maine, which covered records of nearly 95\% of the statewide population. The model was developed from 125,896 patients aged at least 65 years who were discharged from any care facility in the Health Information Exchange network from September 5, 2013, to September 4, 2015. Validation was conducted using 153,199 patients with same inclusion and exclusion criteria from September 5, 2014, to September 4, 2016. Patients were stratified into risk groups. The association between all-cause 1-year mortality and risk factors was screened by chi-squared test and manually reviewed by 2 clinicians. We calculated risk scores for individual patients using a gradient tree-based boost algorithm, which measured the probability of mortality within the next year based on the preceding 1-year clinical profile. Results: The development sample included 125,896 patients (72,572 women, 57.64\%; mean 74.2 [SD 7.7] years). The final validation cohort included 153,199 patients (88,177 women, 57.56\%; mean 74.3 [SD 7.8] years). The c-statistic for discrimination was 0.96 (95\% CI 0.93-0.98) in the development group and 0.91 (95\% CI 0.90-0.94) in the validation cohort. The mortality was 0.99\% in the low-risk group, 16.75\% in the intermediate-risk group, and 72.12\% in the high-risk group. A total of 99 independent risk factors (n=99) for mortality were identified (reported as odds ratios; 95\% CI). Age was on the top of list (1.41; 1.06-1.48); congestive heart failure (20.90; 15.41-28.08) and different tumor sites were also recognized as driving risk factors, such as cancer of the ovaries (14.42; 2.24-53.04), colon (14.07; 10.08-19.08), and stomach (13.64; 3.26-86.57). Disparities were also found in patients' social determinants like respiratory hazard index (1.24; 0.92-1.40) and unemployment rate (1.18; 0.98-1.24). Among high-risk patients who expired in our dataset, cerebrovascular accident, amputation, and type 1 diabetes were the top 3 diseases in terms of average cost in the last year of life. Conclusions: Our study prospectively validated an accurate 1-year risk prediction model and stratification for the elderly population (?65 years) at risk of mortality with statewide electronic medical record datasets. It should be a valuable adjunct for helping patients to make better quality-of-life choices and alerting care givers to target high-risk elderly for appropriate care and discussions, thus cutting back on futile treatment. ",
doi="10.2196/10311",
url="http://www.jmir.org/2018/6/e10311/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29866643"
}


@Article{info:doi/10.2196/10507,
author="Bian, Jiantao
and Weir, Charlene
and Unni, Prasad
and Borbolla, Damian
and Reese, Thomas
and Wan, Jacob Yik-Ki
and Del Fiol, Guilherme",
title="Interactive Visual Displays for Interpreting the Results of Clinical Trials: Formative Evaluation With Case Vignettes",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="25",
volume="20",
number="6",
pages="e10507",
keywords="clinical decision-making",
keywords="clinician information needs",
keywords="information display",
keywords="information foraging theory",
keywords="information seeking behavior",
abstract="Background: At the point of care, evidence from randomized controlled trials (RCTs) is underutilized in helping clinicians meet their information needs. Objective: To design interactive visual displays to help clinicians interpret and compare the results of relevant RCTs for the management of a specific patient, and to conduct a formative evaluation with physicians comparing interactive visual versus narrative displays. Methods: We followed a user-centered and iterative design process succeeded by development of information display prototypes as a Web-based application. We then used a within-subjects design with 20 participants (8 attendings and 12 residents) to evaluate the usability and problem-solving impact of the information displays. We compared subjects' perceptions of the interactive visual displays versus narrative abstracts. Results: The resulting interactive visual displays present RCT results side-by-side according to the Population, Intervention, Comparison, and Outcome (PICO) framework. Study participants completed 19 usability tasks in 3 to 11 seconds with a success rate of 78\% to 100\%. Participants favored the interactive visual displays over narrative abstracts according to perceived efficiency, effectiveness, effort, user experience and preference (all P values <.001). Conclusions: When interpreting and applying RCT findings to case vignettes, physicians preferred interactive graphical and PICO-framework-based information displays that enable direct comparison of the results from multiple RCTs compared to the traditional narrative and study-centered format. Future studies should investigate the use of interactive visual displays to support clinical decision making in care settings and their effect on clinician and patient outcomes. ",
doi="10.2196/10507",
url="http://www.jmir.org/2018/6/e10507/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29941416"
}


@Article{info:doi/10.2196/jmir.9959,
author="Albarracin, Dolores
and Romer, Daniel
and Jones, Christopher
and Hall Jamieson, Kathleen
and Jamieson, Patrick",
title="Misleading Claims About Tobacco Products in YouTube Videos: Experimental Effects of Misinformation on Unhealthy Attitudes",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="29",
volume="20",
number="6",
pages="e229",
keywords="health communication",
keywords="tobacco",
abstract="Background: Recent content analyses of YouTube postings reveal a proliferation of user generated videos with misleading statements about the health consequences of various types of nontraditional tobacco use (eg, electronic cigarettes; e-cigarettes). Objective: This research was aimed at obtaining evidence about the potential effects of YouTube postings about tobacco products on viewers' attitudes toward these products. Methods: A sample of young adults recruited online (N=350) viewed one of four highly viewed YouTube videos containing misleading health statements about chewing tobacco, e-cigarettes, hookahs, and pipe smoking, as well as a control YouTube video unrelated to tobacco products. Results: The videos about e-cigarettes and hookahs led to more positive attitudes toward the featured products than did control videos. However, these effects did not fully translate into attitudes toward combustive cigarette smoking, although the pipe video led to more positive attitudes toward combustive smoking than did the chewing and the hookah videos, and the e-cigarette video led to more positive attitudes toward combustive cigarette smoking than did the chewing video. Conclusions: This research revealed young people's reactions to misleading claims about tobacco products featured in popular YouTube videos. Policy implications are discussed. ",
doi="10.2196/jmir.9959",
url="http://www.jmir.org/2018/6/e229/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29959113"
}


@Article{info:doi/10.2196/jmir.9829,
author="Zhao, Jingsong
and Mir, Nageen
and Ackermann, Nicole
and Kaphingst, A. Kimberly
and Politi, C. Mary",
title="Dissemination of a Web-Based Tool for Supporting Health Insurance Plan Decisions (Show Me Health Plans): Cross-Sectional Observational Study",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="20",
volume="20",
number="6",
pages="e209",
keywords="Affordable Care Act",
keywords="health insurance decision aid",
keywords="health literacy",
keywords="public health",
abstract="Background: The rate of uninsured people has decreased dramatically since the Affordable Care Act was passed. To make an informed decision, consumers need assistance to understand the advantages and disadvantages of health insurance plans. The Show Me Health Plans Web-based decision support tool was developed to improve the quality of health insurance selection. In response to the promising effectiveness of Show Me Health Plans in a randomized controlled trial (RCT) and the growing need for Web-based health insurance decision support, the study team used expert recommendations for dissemination and implementation, engaged external stakeholders, and made the Show Me Health Plans tool available to the public. Objective: The purpose of this study was to implement the public dissemination of the Show Me Health Plans tool in the state of Missouri and to evaluate its impact compared to the RCT. Methods: This study used a cross-sectional observational design. Dissemination phase users were compared with users in the RCT study across the same outcome measures. Time spent using the Show Me Health Plans tool, knowledge, importance rating of 9 health insurance features, and intended plan choice match with algorithm predictions were examined. Results: During the dissemination phase (November 2016 to January 2017), 10,180 individuals visited the SMHP website, and the 1069 users who stayed on the tool for more than one second were included in our analyses. Dissemination phase users were more likely to live outside St. Louis City or County (P<.001), were less likely to be below the federal poverty level (P<.001), and had a higher income (P=.03). Overall, Show Me Health Plans users from St. Louis City or County spent more time on the Show Me Health Plans tool than those from other Missouri counties (P=.04); this association was not observed in the RCT. Total time spent on the tool was not correlated with knowledge scores, which were associated with lower poverty levels (P=.009). The users from the RCT phase were more likely to select an insurance plan that matched the tool's recommendations (P<.001) compared with the dissemination phase users. Conclusions: The study suggests that a higher income population may be more likely to seek information and online help when making a health insurance plan decision. We found that Show Me Health Plans users in the dissemination phase were more selective in the information they reviewed. This study illustrates one way of disseminating and implementing an empirically tested Web-based decision aid tool. Distributing Web-based tools is feasible and may attract a large number of potential users, educate them on basic health insurance information, and make recommendations based on personal information and preference. However, using Web-based tools may differ according to the demographics of the general public compared to research study participants. ",
doi="10.2196/jmir.9829",
url="http://www.jmir.org/2018/6/e209/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29925498"
}


@Article{info:doi/10.2196/10332,
author="Bernard, Florian
and Lem{\'e}e, Jean-Michel
and Aubin, Ghislaine
and Ter Minassian, Aram
and Menei, Philippe",
title="Using a Virtual Reality Social Network During Awake Craniotomy to Map Social Cognition: Prospective Trial",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="26",
volume="20",
number="6",
pages="e10332",
keywords="virtual reality",
keywords="neurosurgery",
keywords="social cognition",
keywords="awake surgery",
abstract="Background: In awake craniotomy, it is possible to temporarily inactivate regions of the brain using direct electrical stimulation, while the patient performs neuropsychological tasks. If the patient shows decreased performance in a given task, the neurosurgeon will not remove these regions, so as to maintain all brain functions. Objective: The objective of our study was to describe our experience of using a virtual reality (VR) social network during awake craniotomy and discuss its future applications for perioperative mapping of nonverbal language, empathy, and theory of mind. Methods: This was a single-center, prospective, unblinded trial. During wound closure, different VR experiences with a VR headset were proposed to the patient. This project sought to explore interactions with the neuropsychologist's avatar in virtual locations using a VR social network as an available experience. Results: Three patients experienced VR. Despite some limitations due to patient positioning during the operation and the limitation of nonverbal cues inherent to the app, the neuropsychologist, as an avatar, could communicate with the patient and explore gesture communication while wearing a VR headset. Conclusions: With some improvements, VR social networks can be used in the near future to map social cognition during awake craniotomy. Trial Registration: ClinicalTrials.gov NCT03010943; https://clinicaltrials.gov/ct2/show/NCT03010943 (Archived at WebCite at http://www.webcitation.org/70CYDil0P) ",
doi="10.2196/10332",
url="http://www.jmir.org/2018/6/e10332/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29945859"
}


@Article{info:doi/10.2196/10281,
author="Del Fiol, Guilherme
and Michelson, Matthew
and Iorio, Alfonso
and Cotoi, Chris
and Haynes, Brian R.",
title="A Deep Learning Method to Automatically Identify Reports of Scientifically Rigorous Clinical Research from the Biomedical Literature: Comparative Analytic Study",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="25",
volume="20",
number="6",
pages="e10281",
keywords="information retrieval",
keywords="evidence-based medicine",
keywords="deep learning",
keywords="machine learning",
keywords="literature databases",
abstract="Background: A major barrier to the practice of evidence-based medicine is efficiently finding scientifically sound studies on a given clinical topic. Objective: To investigate a deep learning approach to retrieve scientifically sound treatment studies from the biomedical literature. Methods: We trained a Convolutional Neural Network using a noisy dataset of 403,216 PubMed citations with title and abstract as features. The deep learning model was compared with state-of-the-art search filters, such as PubMed's Clinical Query Broad treatment filter, McMaster's textword search strategy (no Medical Subject Heading, MeSH, terms), and Clinical Query Balanced treatment filter. A previously annotated dataset (Clinical Hedges) was used as the gold standard. Results: The deep learning model obtained significantly lower recall than the Clinical Queries Broad treatment filter (96.9\% vs 98.4\%; P<.001); and equivalent recall to McMaster's textword search (96.9\% vs 97.1\%; P=.57) and Clinical Queries Balanced filter (96.9\% vs 97.0\%; P=.63). Deep learning obtained significantly higher precision than the Clinical Queries Broad filter (34.6\% vs 22.4\%; P<.001) and McMaster's textword search (34.6\% vs 11.8\%; P<.001), but was significantly lower than the Clinical Queries Balanced filter (34.6\% vs 40.9\%; P<.001). Conclusions: Deep learning performed well compared to state-of-the-art search filters, especially when citations were not indexed. Unlike previous machine learning approaches, the proposed deep learning model does not require feature engineering, or time-sensitive or proprietary features, such as MeSH terms and bibliometrics. Deep learning is a promising approach to identifying reports of scientifically rigorous clinical research. Further work is needed to optimize the deep learning model and to assess generalizability to other areas, such as diagnosis, etiology, and prognosis. ",
doi="10.2196/10281",
url="http://www.jmir.org/2018/6/e10281/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29941415"
}


@Article{info:doi/10.2196/jmir.9105,
author="Rothenfluh, Fabia
and Schulz, J. Peter",
title="Content, Quality, and Assessment Tools of Physician-Rating Websites in 12 Countries: Quantitative Analysis",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="14",
volume="20",
number="6",
pages="e212",
keywords="physician rating websites",
keywords="content analysis",
keywords="website quality",
keywords="patient Web portals",
keywords="rating tools",
keywords="health information",
keywords="health care quality assessment",
keywords="patient reviews",
abstract="Background: Websites on which users can rate their physician are becoming increasingly popular, but little is known about the website quality, the information content, and the tools they offer users to assess physicians. This study assesses these aspects on physician-rating websites in German- and English-speaking countries. Objective: The objective of this study was to collect information on websites with a physician rating or review tool in 12 countries in terms of metadata, website quality (transparency, privacy and freedom of speech of physicians and patients, check mechanisms for appropriateness and accuracy of reviews, and ease of page navigation), professional information about the physician, rating scales and tools, as well as traffic rank. Methods: A systematic Web search based on a set of predefined keywords was conducted on Google, Bing, and Yahoo in August 2016. A final sample of 143 physician-rating websites was analyzed and coded for metadata, quality, information content, and the physician-rating tools. Results: The majority of websites were registered in the United States (40/143) or Germany (25/143). The vast majority were commercially owned (120/143, 83.9\%), and 69.9\% (100/143) displayed some form of physician advertisement. Overall, information content (mean 9.95/25) as well as quality were low (mean 18.67/47). Websites registered in the United Kingdom obtained the highest quality scores (mean 26.50/47), followed by Australian websites (mean 21.50/47). In terms of rating tools, physician-rating websites were most frequently asking users to score overall performance, punctuality, or wait time in practice. Conclusions: This study evidences that websites that provide physician rating should improve and communicate their quality standards, especially in terms of physician and user protection, as well as transparency. In addition, given that quality standards on physician-rating websites are low overall, the development of transparent guidelines is required. Furthermore, attention should be paid to the financial goals that the majority of physician-rating websites, especially the ones that are commercially owned, pursue. ",
doi="10.2196/jmir.9105",
url="http://www.jmir.org/2018/6/e212/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29903704"
}


@Article{info:doi/10.2196/jmir.9256,
author="Li, Jinshuo
and Parrott, Steve
and Sweeting, Michael
and Farmer, Andrew
and Ross, Jamie
and Dack, Charlotte
and Pal, Kingshuk
and Yardley, Lucy
and Barnard, Maria
and Hudda, Mohammed
and Alkhaldi, Ghadah
and Murray, Elizabeth",
title="Cost-Effectiveness of Facilitated Access to a Self-Management Website, Compared to Usual Care, for Patients With Type 2 Diabetes (HeLP-Diabetes): Randomized Controlled Trial",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="08",
volume="20",
number="6",
pages="e201",
keywords="cost-effectiveness",
keywords="type 2 diabetes mellitus",
keywords="self-management",
keywords="internet",
abstract="Background: Type 2 diabetes mellitus is one of the most common long-term conditions, and costs health services approximately 10\% of their total budget. Active self-management by patients improves outcomes and reduces health service costs. While the existing evidence suggested that uptake of self-management education was low, the development of internet-based technology might improve the situation. Objective: To establish the cost-effectiveness of a Web-based self-management program for people with type 2 diabetes (HeLP-Diabetes) compared to usual care. Methods: An incremental cost-effectiveness analysis was conducted, from a National Health Service and personal and social services perspective, based on data collected from a multi-center, two-arm individually randomized controlled trial over 12 months. Adults aged 18 or over with a diagnosis of type 2 diabetes and registered with the 21 participating general practices (primary care) in England, UK, were approached. People who were unable to provide informed consent or to use the intervention, terminally ill, or currently participating in a trial of an alternative self-management intervention, were excluded. The participants were then randomized to either usual care plus HeLP-Diabetes, an interactive, theoretically-informed Web-based self-management program, or to usual care plus access to a comparator website containing basic information only. The participants' intervention costs and wider health care resource use were collected as well as two health-related quality of life measures: the Problem Areas in Diabetes (PAID) Scale and EQ-5D-3L. EQ-5D-3L was then used to calculate quality-adjusted life years (QALYs). The primary analysis was based on intention-to-treat, using multiple imputation to handle the missing data. Results: In total, 374 participants were randomized, with 185 in the intervention group and 189 in the control group. The primary analysis showed incremental cost-effectiveness ratios of {\textsterling}58 (95\% CI --411 to 587) per unit improvement on PAID scale and {\textsterling}5550 (95\% CI --21,077 to 52,356) per QALY gained by HeLP-Diabetes, compared to the control. The complete case analysis showed less cost-effectiveness and higher uncertainty with incremental cost-effectiveness ratios of {\textsterling}116 (95\% CI --1299 to 1690) per unit improvement on PAID scale and {\textsterling}18,500 (95\% CI --203,949 to 190,267) per QALY. The cost-effectiveness acceptability curve showed an 87\% probability of cost-effectiveness at {\textsterling}20,000 per QALY willingness-to-pay threshold. The one-way sensitivity analyses estimated 363 users would be needed to use the intervention for it to become less costly than usual care. Conclusions: Facilitated access to HeLP-Diabetes is cost-effective, compared to usual care, under the recommended threshold of {\textsterling}20,000 to {\textsterling}30,000 per QALY by National Institute of Health and Care Excellence. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 02123133; http://www.controlled-trials.com/ISRCTN02123133 (Archived by WebCite at http://www.webcitation.org/6zqjhmn00) ",
doi="10.2196/jmir.9256",
url="http://www.jmir.org/2018/6/e201/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29884608"
}


@Article{info:doi/10.2196/jmir.9225,
author="Turner, M. Ralph
and Ma, Qinli
and Lorig, Kate
and Greenberg, Jay
and DeVries, R. Andrea",
title="Evaluation of a Diabetes Self-Management Program: Claims Analysis on Comorbid Illnesses, Health Care Utilization, and Cost",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="22",
volume="20",
number="6",
pages="e207",
keywords="diabetes mellitus",
keywords="patient education",
keywords="health care utilization",
keywords="cost",
abstract="Background: An estimated 30.3 million Americans have diabetes mellitus. The US Department of Health and Human Services created national objectives via its Healthy People 2020 initiative to improve the quality of life for people who either have or are at risk for diabetes mellitus, and hence, lower the personal and national economic burden of this debilitating chronic disease. Diabetes self-management education interventions are a primary focus of this initiative. Objective: The aim of this study was to evaluate the impact of the Better Choices Better Health Diabetes (BCBH-D) self-management program on comorbid illness related to diabetes mellitus, health care utilization, and cost. Methods: A propensity score matched two-group, pre-post design was used for this study. Retrospective administrative medical and pharmacy claims data from the HealthCore Integrated Research Environment were used for outcome variables. The intervention cohort included diabetes mellitus patients who were recruited to a diabetes self-management program. Control cohort subjects were identified from the HealthCore Integrated Research Environment by at least two diabetes-associated claims (International Classification of Diseases-Ninth Revision, ICD-9 250.xx) within 2 years before the program launch date (October 1, 2011-September 30, 2013) but did not participate in BCBH-D. Controls were matched to cases in a 3:1 propensity score match. Outcome measures included pre- and postintervention all-cause and diabetes-related utilization and costs. Cost outcomes are reported as least squares means. Repeated measures analyses (generalized estimating equation approach) were conducted for utilization, comorbid conditions, and costs. Results: The program participants who were identified in HealthCore Integrated Research Environment claims (N=558) were matched to a control cohort of 1669 patients. Following the intervention, the self-management cohort experienced significant reductions for diabetes mellitus--associated comorbid conditions, with the postintervention disease burden being significantly lower (mean 1.6 [SD 1.6]) compared with the control cohort (mean 2.1 [SD 1.7]; P=.001). Postintervention all-cause utilization was decreased in the intervention cohort compared with controls with ?40/1000 emergency department visits vs +70/1000; P=.004 and ?5780 outpatient visits per 1000 vs ?290/1000; P=.001. Unadjusted total all-cause medical cost was decreased by US \$2207 in the intervention cohort compared with a US \$338 decrease in the controls; P=.001. After adjustment for other variables through structural equation analysis, the direct effect of the BCBH-D was --US \$815 (P=.049). Conclusions: Patients in the BCBH-D program experienced reduced all-cause health care utilization and costs. Direct cost savings were US \$815. Although encouraging, given the complexity of the patient population, further study is needed to cross-validate the results. ",
doi="10.2196/jmir.9225",
url="http://www.jmir.org/2018/6/e207/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29934284"
}


@Article{info:doi/10.2196/10148,
author="Morris, R. Robert
and Kouddous, Kareem
and Kshirsagar, Rohan
and Schueller, M. Stephen",
title="Towards an Artificially Empathic Conversational Agent for Mental Health Applications: System Design and User Perceptions",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="26",
volume="20",
number="6",
pages="e10148",
keywords="conversational agents",
keywords="mental health",
keywords="empathy",
keywords="crowdsourcing",
keywords="peer support",
abstract="Background: Conversational agents cannot yet express empathy in nuanced ways that account for the unique circumstances of the user. Agents that possess this faculty could be used to enhance digital mental health interventions. Objective: We sought to design a conversational agent that could express empathic support in ways that might approach, or even match, human capabilities. Another aim was to assess how users might appraise such a system. Methods: Our system used a corpus-based approach to simulate expressed empathy. Responses from an existing pool of online peer support data were repurposed by the agent and presented to the user. Information retrieval techniques and word embeddings were used to select historical responses that best matched a user's concerns. We collected ratings from 37,169 users to evaluate the system. Additionally, we conducted a controlled experiment (N=1284) to test whether the alleged source of a response (human or machine) might change user perceptions. Results: The majority of responses created by the agent (2986/3770, 79.20\%) were deemed acceptable by users. However, users significantly preferred the efforts of their peers (P<.001). This effect was maintained in a controlled study (P=.02), even when the only difference in responses was whether they were framed as coming from a human or a machine. Conclusions: Our system illustrates a novel way for machines to construct nuanced and personalized empathic utterances. However, the design had significant limitations and further research is needed to make this approach viable. Our controlled study suggests that even in ideal conditions, nonhuman agents may struggle to express empathy as well as humans. The ethical implications of empathic agents, as well as their potential iatrogenic effects, are also discussed. ",
doi="10.2196/10148",
url="http://www.jmir.org/2018/6/e10148/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29945856"
}


@Article{info:doi/10.2196/10048,
author="Bauer, M. Amy
and Hodsdon, Sarah
and Bechtel, M. Jared
and Fortney, C. John",
title="Applying the Principles for Digital Development: Case Study of a Smartphone App to Support Collaborative Care for Rural Patients With Posttraumatic Stress Disorder or Bipolar Disorder",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="06",
volume="20",
number="6",
pages="e10048",
keywords="mHealth",
keywords="mental health",
keywords="primary health care",
keywords="rural health",
keywords="post-traumatic stress disorders",
keywords="PTSD",
keywords="bipolar disorder",
keywords="depression",
abstract="Background: Despite a proliferation of patient-facing mobile apps for mental disorders, there is little literature guiding efforts to incorporate mobile tools into clinical care delivery and integrate patient-generated data into care processes for patients with complex psychiatric disorders. Objective: The aim of this study was to seek to gain an understanding of how to incorporate a patient-provider mobile health (mHealth) platform to support the delivery of integrated primary care--based mental health services (Collaborative Care) to rural patients with posttraumatic stress disorder and/or bipolar disorder. Methods: Using the Principles for Digital Development as a framework, we describe our experience designing, developing, and deploying a mobile system to support Collaborative Care. The system consists of a patient-facing smartphone app that integrates with a Web-based clinical patient registry used by behavioral health care managers and consulting psychiatrists. Throughout development, we engaged representatives from the system's two user types: (1) providers, who use the Web-based registry and (2) patients, who directly use the mobile app. We extracted mobile metadata to describe the early adoption and use of the system by care managers and patients and report preliminary results from an in-app patient feedback survey that includes a System Usability Scale (SUS). Results: Each of the nine Principles for Digital Development is illustrated with examples. The first 10 patients to use the smartphone app have completed symptom measures on average every 14 days over an average period of 20 weeks. The mean SUS score at week 8 among four patients who completed this measure was 91.9 (range 72.5-100). We present lessons learned about the technical and training requirements for integration into practice that can inform future efforts to incorporate health technologies to improve care for patients with psychiatric conditions. Conclusions: Adhering to the Principles for Digital Development, we created and deployed an mHealth system to support Collaborative Care for patients with complex psychiatric conditions in rural health centers. Preliminary data among the initial users support high system usability and show promise for sustained use. On the basis of our experience, we propose five additional principles to extend this framework and inform future efforts to incorporate health technologies to improve care for patients with psychiatric conditions: design for public health impact, add value for all users, test the product and the process, acknowledge disruption, and anticipate variability. ",
doi="10.2196/10048",
url="http://www.jmir.org/2018/6/e10048/"
}


@Article{info:doi/10.2196/10120,
author="Stawarz, Katarzyna
and Preist, Chris
and Tallon, Debbie
and Wiles, Nicola
and Coyle, David",
title="User Experience of Cognitive Behavioral Therapy Apps for Depression: An Analysis of App Functionality and User Reviews",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="06",
volume="20",
number="6",
pages="e10120",
keywords="mental health",
keywords="mobile apps",
keywords="cognitive behavioral therapy",
keywords="depression",
keywords="user experience",
keywords="mHealth",
abstract="Background: Hundreds of mental health apps are available to the general public. With increasing pressures on health care systems, they offer a potential way for people to support their mental health and well-being. However, although many are highly rated by users, few are evidence-based. Equally, our understanding of what makes apps engaging and valuable to users is limited. Objective: The aim of this paper was to analyze functionality and user opinions of mobile apps purporting to support cognitive behavioral therapy for depression and to explore key factors that have an impact on user experience and support engagement. Methods: We systematically identified apps described as being based on cognitive behavioral therapy for depression. We then conducted 2 studies. In the first, we analyzed the therapeutic functionality of apps. This corroborated existing work on apps' fidelity to cognitive behavioral therapy theory, but we also extended prior work by examining features designed to support user engagement. Engagement features found in cognitive behavioral therapy apps for depression were compared with those found in a larger group of apps that support mental well-being in a more general sense. Our second study involved a more detailed examination of user experience, through a thematic analysis of publicly available user reviews of cognitive behavioral therapy apps for depression. Results: We identified 31 apps that purport to be based on cognitive behavioral therapy for depression. Functionality analysis (study 1) showed that they offered an eclectic mix of features, including many not based on cognitive behavioral therapy practice. Cognitive behavioral therapy apps used less varied engagement features compared with 253 other mental well-being apps. The analysis of 1287 user reviews of cognitive behavioral therapy apps for depression (study 2) showed that apps are used in a wide range of contexts, both replacing and augmenting therapy, and allowing users to play an active role in supporting their mental health and well-being. Users, including health professionals, valued and used apps that incorporated both core cognitive behavioral therapy and non-cognitive behavioral therapy elements, but concerns were also expressed regarding the unsupervised use of apps. Positivity was seen as important to engagement, for example, in the context of automatic thoughts, users expressed a preference to capture not just negative but also positive ones. Privacy, security, and trust were crucial to the user experience. Conclusions: Cognitive behavioral therapy apps for depression need to improve with respect to incorporating evidence-based cognitive behavioral therapy elements. Equally, a positive user experience is dependent on other design factors, including consideration of varying contexts of use. App designers should be able to clearly identify the therapeutic basis of their apps, but they should also draw on evidence-based strategies to support a positive and engaging user experience. The most effective apps are likely to strike a balance between evidence-based cognitive behavioral therapy strategies and evidence-based design strategies, including the possibility of eclectic therapeutic techniques. ",
doi="10.2196/10120",
url="http://www.jmir.org/2018/6/e10120/"
}


@Article{info:doi/10.2196/10141,
author="Schueller, M. Stephen
and Neary, Martha
and O'Loughlin, Kristen
and Adkins, C. Elizabeth",
title="Discovery of and Interest in Health Apps Among Those With Mental Health Needs: Survey and Focus Group Study",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="11",
volume="20",
number="6",
pages="e10141",
keywords="mHealth",
keywords="mental health",
keywords="mobile apps",
keywords="consumer preference",
keywords="focus groups",
abstract="Background: A large number of health apps are available directly to consumers through app marketplaces. Little information is known, however, about how consumers search for these apps and which factors influence their uptake, adoption, and long-term use. Objective: The aim of this study was to understand what people look for when they search for health apps and the aspects and features of those apps that consumers find appealing. Methods: Participants were recruited from Northwestern University's Center for Behavioral Intervention Technologies' research registry of individuals with mental health needs. Most participants (n=811) completed a survey asking about their use and interest in health and mental health apps. Local participants were also invited to participate in focus groups. A total of 7 focus groups were conducted with 30 participants that collected more detailed information about their use and interest in health and mental health apps. Results: Survey participants commonly found health apps through social media (45.1\%, 366/811), personal searches (42.7\%, 346/811), or word of mouth (36.9\%, 299/811), as opposed to professional sources such as medical providers (24.6\%, 200/811). From the focus groups, common themes related to uptake and use of health apps included the importance of personal use before adoption, specific features that users found desirable, and trusted sources either developing or promoting the apps. Conclusions: As the number of mental health and health apps continue to increase, it is imperative to better understand the factors that impact people's adoption and use of such technologies. Our findings indicated that a number of factors---ease of use, aesthetics, and individual experience---drove adoption and use and highlighted areas of focus for app developers and disseminators. ",
doi="10.2196/10141",
url="http://www.jmir.org/2018/6/e10141/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29891468"
}


@Article{info:doi/10.2196/10136,
author="Kornfield, Rachel
and Sarma, K. Prathusha
and Shah, V. Dhavan
and McTavish, Fiona
and Landucci, Gina
and Pe-Romashko, Klaren
and Gustafson, H. David",
title="Detecting Recovery Problems Just in Time: Application of Automated Linguistic Analysis and Supervised Machine Learning to an Online Substance Abuse Forum",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="12",
volume="20",
number="6",
pages="e10136",
keywords="self-help groups",
keywords="substance-related disorders",
keywords="supervised machine learning",
keywords="social support",
keywords="health communication",
abstract="Background: Online discussion forums allow those in addiction recovery to seek help through text-based messages, including when facing triggers to drink or use drugs. Trained staff (or ``moderators'') may participate within these forums to offer guidance and support when participants are struggling but must expend considerable effort to continually review new content. Demands on moderators limit the scalability of evidence-based digital health interventions. Objective: Automated identification of recovery problems could allow moderators to engage in more timely and efficient ways with participants who are struggling. This paper aimed to investigate whether computational linguistics and supervised machine learning can be applied to successfully flag, in real time, those discussion forum messages that moderators find most concerning. Methods: Training data came from a trial of a mobile phone-based health intervention for individuals in recovery from alcohol use disorder, with human coders labeling discussion forum messages according to whether or not authors mentioned problems in their recovery process. Linguistic features of these messages were extracted via several computational techniques: (1) a Bag-of-Words approach, (2) the dictionary-based Linguistic Inquiry and Word Count program, and (3) a hybrid approach combining the most important features from both Bag-of-Words and Linguistic Inquiry and Word Count. These features were applied within binary classifiers leveraging several methods of supervised machine learning: support vector machines, decision trees, and boosted decision trees. Classifiers were evaluated in data from a later deployment of the recovery support intervention. Results: To distinguish recovery problem disclosures, the Bag-of-Words approach relied on domain-specific language, including words explicitly linked to substance use and mental health (``drink,'' ``relapse,'' ``depression,'' and so on), whereas the Linguistic Inquiry and Word Count approach relied on language characteristics such as tone, affect, insight, and presence of quantifiers and time references, as well as pronouns. A boosted decision tree classifier, utilizing features from both Bag-of-Words and Linguistic Inquiry and Word Count performed best in identifying problems disclosed within the discussion forum, achieving 88\% sensitivity and 82\% specificity in a separate cohort of patients in recovery. Conclusions: Differences in language use can distinguish messages disclosing recovery problems from other message types. Incorporating machine learning models based on language use allows real-time flagging of concerning content such that trained staff may engage more efficiently and focus their attention on time-sensitive issues. ",
doi="10.2196/10136",
url="http://www.jmir.org/2018/6/e10136/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29895517"
}


@Article{info:doi/10.2196/10001,
author="Bauer, M. Amy
and Baldwin, A. Scott
and Anguera, A. Joaquin
and Are{\'a}n, A. Patricia
and Atkins, C. David",
title="Comparing Approaches to Mobile Depression Assessment for Measurement-Based Care: Prospective Study",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="19",
volume="20",
number="6",
pages="e10001",
keywords="Patient Health Questionnaire",
keywords="depression",
keywords="mobile health",
keywords="symptom assessment",
abstract="Background: To inform measurement-based care, practice guidelines suggest routine symptom monitoring, often on a weekly or monthly basis. Increasingly, patient-provider contacts occur remotely (eg, by telephone and Web-based portals), and mobile health tools can now monitor depressed mood daily or more frequently. However, the reliability and utility of daily ratings are unclear. Objective: This study aimed to examine the association between a daily depressive symptom measure and the Patient Health Questionnaire-9 (PHQ-9), the most widely adopted depression self-report measure, and compare how well these 2 assessment methods predict patient outcomes. Methods: A total of 547 individuals completed smartphone-based measures, including the Patient Health Questionnaire-2 (PHQ-2) modified for daily administration, the PHQ-9, and the Sheehan Disability Scale. Multilevel factor analyses evaluated the reliability of latent depression based on the PHQ-2 (for repeated measures) between weeks 2 and 4 and its correlation with the PHQ-9 at week 4. Regression models predicted week 8 depressive symptoms and disability ratings with daily PHQ-2 and PHQ-9. Results: The daily PHQ-2 and PHQ-9 are highly reliable (range: 0.80-0.88) and highly correlated (r=.80). Findings were robust across demographic groups (age, gender, and ethnic minority status). Daily PHQ-2 and PHQ-9 were comparable in predicting week 8 disability and were independent predictors of week 8 depressive symptoms and disability, though the unique contribution of the PHQ-2 was small in magnitude. Conclusions: Daily completion of the PHQ-2 is a reasonable proxy for the PHQ-9 and is comparable to the PHQ-9 in predicting future outcomes. Mobile assessment methods offer researchers and clinicians reliable and valid new methods for depression assessment that may be leveraged for measurement-based depression care. ",
doi="10.2196/10001",
url="http://www.jmir.org/2018/6/e10001/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29921564"
}


@Article{info:doi/10.2196/jmir.9638,
author="Donnelly, Susie
and Reginatto, Brenda
and Kearns, Oisin
and Mc Carthy, Marie
and Byrom, Bill
and Muehlhausen, Willie
and Caulfield, Brian",
title="The Burden of a Remote Trial in a Nursing Home Setting: Qualitative Study",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="19",
volume="20",
number="6",
pages="e220",
keywords="mHealth",
keywords="patient burden",
keywords="remote trial",
keywords="clinical trial methodology",
keywords="wearable technology",
keywords="activity monitors",
abstract="Background: Despite an aging population, older adults are typically underrecruited in clinical trials, often because of the perceived burden associated with participation, particularly travel associated with clinic visits. Conducting a clinical trial remotely presents an opportunity to leverage mobile and wearable technologies to bring the research to the patient. However, the burden associated with shifting clinical research to a remote site requires exploration. While a remote trial may reduce patient burden, the extent to which this shifts burden on the other stakeholders needs to be investigated. Objective: The aim of this study was to explore the burden associated with a remote trial in a nursing home setting on both staff and residents. Methods: Using results from a grounded analysis of qualitative data, this study explored and characterized the burden associated with a remote trial conducted in a nursing home in Dublin, Ireland. A total of 11 residents were recruited to participate in this trial (mean age: 80 years; age range: 67-93 years). To support research activities, we also recruited 10 nursing home staff members, including health care assistants, an activities co-ordinator, and senior nurses. This study captured the lived experience of this remote trial among staff and residents and explored the burden associated with participation. At the end of the trial, a total of 6 residents and 8 members of staff participated in semistructured interviews (n=14). They reviewed clinical data generated by mobile and wearable devices and reflected upon their trial-related experiences. Results: Staff reported extensive burden in fulfilling their roles and responsibilities to support activities of the trial. Among staff, we found eight key characteristics of burden: (1) comprehension, (2) time, (3) communication, (4) emotional load, (5) cognitive load, (6) research engagement, (7) logistical burden, and (8) product accountability. Residents reported comparatively less burden. Among residents, we found only four key characteristics of burden: (1) comprehension, (2) adherence, (3) emotional load, and (4) personal space. Conclusions: A remote trial in a nursing home setting can minimize the burden on residents and enable inclusive participation. However, it arguably creates additional burden on staff, particularly where they have a role to play in locally supporting and maintaining technology as part of data collection. Future research should examine how to measure and minimize the burden associated with data collection in remote trials. ",
doi="10.2196/jmir.9638",
url="http://www.jmir.org/2018/6/e220/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29921563"
}